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The laryngectomy emergency algorithm is very similar to the tracheostomy algorithm, however, there are a few key differences.
Considering the anatomical and physiological differences, would you expect to see the following elements in the laryngectomy algorithm?
Select one or more options from the answers below.
Correct.
Not quite right.
Incorrect.
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A. Correct. Overall, far more patients with tracheostomies are harmed by not applying oxygen to the face and stoma. This is the default emergency action for all 'neck-breathing' patients. It will not do any good for laryngectomy patients, but it will not do any harm either, and if there is confusion about the type of stoma, then it might help. Clearly if you know that a patient has a laryngectomy, there is no point in applying oxygen to the face.
B. Incorrect. Laryngectomy patients cannot be orally intubated.
C. Incorrect. 'Speaking valves' can cause confusion. Some laryngectomy patients have a tube in the stoma (particularly in hospital) and a one-way speaking valve may be applied in error. However, sometimes patients have an artificial fistulae formed between their trachea and oesophagus to allow attempts at speech (a 'TEP' valve). If a TEP valve is fitted for this purpose, trying to remove it will not help and may worsen the situation.
D. Correct. These may help to 'rail-road' a new tube into place or provide oxygenation.
E. Correct. Whilst a false tract is very unlikely, inspection visually with a 'scope can reveal the source of obstruction and ensure correct tube placement. There are comprehensive resources to help manage patients with laryngectomies in related modules.
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