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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, January 3, 2022

Post-Laryngectomy Patient

EemDocs - January 03, 2021 - By Cameron Jones and Dana Loke
Reviewed by: Alexander Y. Sheng; Alex Koyfman; Brit 
Take-Home Points
  • Patients who have undergone laryngectomies have no connection between their lower and upper airway and can only be oxygenated and ventilated via their stoma.
  • Some tracheostomy patients must be functionally treated as laryngectomy patients, as they have a very limited or non-patent upper airway due to stenosis, mass, etc.
  • In all patients with anterior neck stomas who present to the ED, initially apply O2 to both the face and neck but immediately attempt to determine upper airway patency via history, examination of the stoma, or absence of end-tidal CO2 waveform at the face.
  • Emergency oxygenation at a tracheal stoma is best applied with a BVM fitted with a pediatric facemask or with a laryngeal mask airway (LMA).
  • For the patient with a laryngectomy in respiratory distress, the primary tasks are to apply supportive oxygen, assess stoma patency and establish a definitive airway if necessary.
  • If the patient stops breathing, arrests, or decompensates, intubate the tracheal stoma using a 6.0 ETT over a bougie or fiberoptic device.