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.
