Things had been going smoothly after Karlie’s first ER visit. We were not having any issues with water in her tubing and she was very stable and doing wonderful. One Saturday morning, about a couple weeks after the first ER visit, Karlie was being especially fussy and her breathing seemed off. We always keep an eye on her breathing, as well as her vent settings. Her ventilator tells us how big of breaths she is taking, how fast she’s breathing, and how much pressure it’s giving her. We were trying everything to calm her down but nothing seemed to work. I was finally able to get Karlie to fall asleep by holding and rocking her, but her breathing still didn’t seem comfortable. We were watching the numbers on her ventilator and her pressure was at its max but the volumes of her breaths were very low. We weren’t sure what to make of it so we just kept a very close eye on her.

Once Karlie woke up from her nap we decided to get her cares done and get her all cleaned up for the day. She was still fussy and not taking very big breaths. Karlie started crying and got herself so worked up that it caused a coughing fit. I picked her up to try and comfort her but she was just so upset. She started coughing so much and so hard that she made herself vomit. After she vomited, she became panicked and began gasping for air. We immediately knew something was wrong and we knew that her trach had to come out. Sterling took her trach out and I rushed to get her Ambubag and back-up trach. Once the trach was out she took a few good big breaths on her own before I started to bag her. I then tried to put a new trach in but was unsuccessful. I felt resistance when I tried to place the trach and that is not something you want to feel. You never want to force the trach in because you could cause some serious damage. We called 911 right away and I continued to breathe for Karlie with the Ambubag until the paramedics arrived.

Thankfully it only took the paramedics a few minutes to arrive. They assessed the situation and advised that we try putting a smaller size trach in. With their help, we were able to successfully insert the smaller trach. Thankfully Karlie never lost consciousness this time around. She wasn’t happy, but at least she wasn’t purple. The paramedics had put a pulse oximeter on Karlie to monitor her heart rate and oxygen levels. Her heart rate was very elevated and her oxygen saturation was lower than it should be. Once the new trach was in and situated, Karlie was happy as a clam. She was being very sweet and giving the paramedics big smiles. Although she was calm and happy, her heart rate was not going down. I thought we had better be safe than sorry so when they asked if we wanted to bring her into the ER, I said yes.

I rode with her in the ambulance this time while Sterling followed behind. When we got to the ER, our trach educator from the NICU was there waiting for us. It was so good to see a familiar face! The ER staff did a whole check-up on Karlie and everything looked great but they wanted to keep her there until her heart rate and saturation returned to normal. Our trach educator stayed with us as much as she could and tried to help us figure out what had happened. When we explained Karlie’s high pressure and low volumes on the ventilator, she was suspicious that a mucus plug had been the culprit. Mucus plugs occur when thick secretions (or goobers as we like to call them) get into the trach and block airflow. Some mucus plugs can be suctioned out but others require the trach to be replaced entirely. While our educator was still with us in the ER, she wanted Sterling and I to change Karlie’s trach again, but this time with her normal size. Karlie was calm and happy, so we had no issues. Our educator thought the reason we couldn’t get it in at home was because Karlie was so panicked and breathing fast and essentially closing up her stoma. This was the second time I had tried to change her trach at home and was unsuccessful. It is very disheartening and terrifying when you try multiple times to change the trach and fail. You only get so many shots when dealing with your child’s lifeline. I was not feeling confident and seriously questioning my abilities.

Karlie’s new trach was placed, her heart rate and oxygen levels were normal, and she was her happy self again so they let us go home. Once we got home the first thing we did was find the trach we had taken out earlier. Sure enough, the entire trach was blocked by a thick mucus plug. We think Karlie’s trach had been partially blocked for most of that morning, and then her vomiting is what caused it to get blocked entirely. It was all very scary but I’m just thankful that Sterling and I knew just what to do and didn’t hesitate for a second.