Emergency Laryngectomy Management
This algorithm is paired with the red bed-head sign and indicates that the patient does not have an upper airway in continuity with the lungs. The principles of the algorithm are the same, without the conventional upper airway management steps. Patients with laryngectomies usually do not have a tracheostomy tube in situ, but may have other devices inserted into their airways to allow speech via the oesophagus (tracheo-oesophageal puncture ‘TEP’ valves). These devices should not be removed  (Fig. 6). The exclusion of the upper airway means laryngectomy patients will not obstruct their airway when laying flat on their back and aspiration of gastric contents is not a concern. In the context of cardiopulmonary resuscitation, chest compressions will generate more significant tidal volumes owing to a reduction in dead space . Oxygen insufflation without ventilation may be reasonably efficacious if ventilation is difficult.
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