"The patient was taken to the operative theater, placed on the OR table. He was prepped and draped for awake tracheostomy. 1% lidocaine was injected into and around his prior tracheostomy site. I then made a horizontal incision and dissected quickly to the trachea. He was only obtaining 60cc of tidal volume although his saturations were at 95 or greater throughout the procedure. His trachea was posterior so a cricoid hook was used to elevate anteriorly. An incision was made in the trachea and a 6-0 cuffed Shiley trach was attempted to be placed. However, given the copious amount of purulent respiratory secretions, my first attempt was unsuccessful. I aspirated a large amount of secretions and was then able to place the trach without difficulty. The cuff was inflated and CO2 return was confirmed.

The trach was then secured with a Posey tie and then sutured in 4 quadrants. He was returned to anesthesia care and transferred to ICU."

Thank you!!