From the Research
For a patient bleeding from a tracheostomy due to neck squamous cell carcinoma (SCC), I recommend immediate management with local measures including suctioning to maintain airway patency, application of topical hemostatic agents such as tranexamic acid-soaked gauze, and gentle pressure around the stoma if possible. Intravenous tranexamic acid (1g over 10 minutes, followed by 1g over 8 hours) can help stabilize the bleeding 1. Urgent consultation with otolaryngology and interventional radiology is essential for definitive management, which may include endoscopic evaluation, cauterization, embolization of feeding vessels, or surgical intervention 2, 3. While awaiting specialist care, maintain hemodynamic stability with fluid resuscitation using crystalloids or blood products if significant blood loss has occurred. Monitor oxygen saturation continuously and have equipment ready for possible intubation if the airway becomes compromised. For patients with known tumor-related bleeding, consideration of palliative radiotherapy (typically 30-40 Gy in 10-15 fractions) may be beneficial for longer-term control 4. This approach addresses both immediate hemostasis needs and the underlying malignant cause of bleeding, recognizing that tumor erosion into vessels requires specialized intervention beyond standard wound care measures. Some key considerations in managing such patients include:
- The importance of a multidisciplinary approach involving otolaryngology, interventional radiology, and palliative care specialists.
- The potential role of embolization in controlling bleeding, as evidenced by studies demonstrating its effectiveness in similar contexts 2, 3.
- The need for careful monitoring and maintenance of airway patency and hemodynamic stability during the management of bleeding from a tracheostomy site.