<prompt> A tracheostomised patient, with Portex tracheostomy tube, in the ward, developed sudden complete blockage of the tube. Which of the following is the best next step in management?Immediate removal of the tracheostomy tubeSuction of tube with sodium bicarbonateSuction of tube with salinejet ventilation  <response>: Sudden complete obstruction of the tracheotomy tube is an emergency situation. Efficacy of other alternatives is in question and will take time aggravating the situation. Immediate removal of the tube is a safe alternative. Portex tracheostomy does not have an inner tube. However, if it were a tracheostomy tube with an inner cannula e.g. Jacksons or Fullers metallic tubes removal of only the inner cannula and not the entire tube would be a better alternative. 