Correct!
5. 2 and 4
The lack of alignment of the distal tip of the tracheostomy tube and the tracheal stripe is disturbing. They should be aligned because they should be in the same plane and so rotation of the patient should not cause the two to be misaligned. This suggests that the tracheostomy tube is not in the trachea.
The air-fluid level is also abnormal. Air-fluid levels can indicate either a lung abcess with air above a cavity containing fluid in the lung or air within the pleural space from an infected pleural space or empyema.
At this juncture a pulmonary/critical care consult was ordered because the ward team thought the patient was in impending respiratory failure for continuous positive airway pressure/noninvasive ventilation (CPAP/NIV).
Which of the following is the next most appropriate step(s) in the management of this patient?