Emergency after total laryngectomy

C. Deliver high-flow oxygen and ventilation through the neck stoma

After total laryngectomy, the lungs are disconnected from the mouth and nose. Oxygenation, suction and ventilation must occur through the stoma; facial oxygen is ineffective except as an initial action when anatomy is uncertain.

Why every option is right or wrong

A. Intubate orally: An oral tube cannot reach the trachea after total laryngectomy.

B. Seal the stoma and continue bag-mask ventilation: Occluding the only airway worsens hypoxia.

C. Deliver high-flow oxygen and ventilation through the neck stoma: After total laryngectomy, the lungs are disconnected from the mouth and nose. Oxygenation, suction and ventilation must occur through the stoma; facial oxygen is ineffective except as an initial action when anatomy is uncertain.

D. Wait for the patient's voice prosthesis to be removed: The prosthesis is not the primary airway and should not delay stoma oxygenation.

E. Perform cricothyrotomy: The patient already has a definitive tracheal stoma below the larynx.

What if the scenario changed?

If it were a tracheostomy rather than laryngectomy and the upper airway were patent, oxygenating both face and stoma would be appropriate during assessment.