Download for FREE today -  special Mnemonics Cheatsheet - so you can be SURE that you have that Must Know information down:  bit.ly/nursing-memory   Outline The 3 C’s C-Choking C-Coughing C-Cyanosis Description A tracheal esophageal fistula (TEF) is a congenital abnormality in which there is an opening between the trachea and the esophagus. Surgery is required to repair the opening before a baby can receive oral nutrition. Signs and symptoms to identify TEF are choking, coughing, and cyanosis.