Not many things that come through the door of the ED phase me anymore, but I have to say that tracheostomy complications still make me very, very nervous. Mainly because once you know what some of the bad complications are (eg the tip eroding into the subclavian artery = patient exsanguinates while drowning on their own blood), and that they have the trache because they have a terrible airway to start with (ie going in from the top is likely to be impossible), you realise that these things are just plain dangerous. I could also envisage a great SCE question relating to trache complications in the Fellowship exam as well. Add to that the fact that the educational resources on traches are sadly lacking, and you have a tricky topic on your hands.
Anyway Kane Guthrie (ED Nurse extraordinaire, tweets as @antidoped) sent me a link to a great post on how to manage the trache patient with respiratory distress. It goes through the different types of trache tubes, and what to do in various combinations of situations depending on the type of tube, how long its been in and whether the patient can be orally intibated.
Recommended reading for your daily ED practice and for the exam.