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Performed on (date) ...........................

Sample edit with local phone numbers. Performed on (date):……………………… Tube size:…………………….. Patient no.:…………………………………. Performed on (date) ........................... Tracheostomy tube size (if present) ................ Hospital / NHS No. .

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Performed on (date) ...........................

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  1. Sampleedit with local phone numbers Performed on (date):……………………… Tube size:…………………….. Patient no.:…………………………………. Performed on (date) ........................... Tracheostomy tube size (if present) ................ Hospital / NHS No. ........................... Indicate tracheostomy type by circling the relevant figure Indicate location and function of any sutures Laryngoscopy grade and notes on upper airway management Any problems with this tracheostomy Emergency: oxygen by face and tube (2 routes), check the tube is patent, suction tube Call: Critical Care Outreach on VOIP 2314, Anaesthesia on Bleep 2606 Cardiac Arrest: 2222 and say, “Cardiac Arrest: patient has tracheostomy” Fibre-optic laryngoscope location: 1. ITU (first choice) or 2. Theatre (ask an ODP)

  2. Sampleedit with local phone numbers

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