Tracheostomy and Laryngectomy - Emergency Management
This section summarises immediate assessment and life‑saving actions for patients with tracheostomies or laryngectomies. Use the National Tracheostomy Safety Project (NTSP) algorithms as the operational backbone for acute decision‑making and follow ABCDE/resuscitation priorities: treat hypoxaemia first and call for senior airway/ENT/anaesthesia/critical‑care help early (NTSP; Resuscitation Council UK).
Overview
- Patients with tracheostomies or laryngectomies have altered airway anatomy and can decompensate rapidly from obstruction, displacement, cuff failure, bleeding or device malfunction.
- A critical error is assuming oral ventilation will ventilate a laryngectomy patient - the stoma is the only airway after laryngectomy.
- Rapid assessment and simple bedside tests usually determine the correct next step.
Key anatomical and clinical differences
Initial priorities and team call
- Follow ABCDE; treat hypoxia first and start monitoring (SpO2, ECG, BP). (Resuscitation Council UK)
- Immediately announce an airway emergency and summon senior airway help (ENT, anaesthetics, critical care) while initiating bedside actions (NTSP, RCEM).
- Apply high‑flow oxygen via the most appropriate route immediately.
Immediate bedside assessment
1. Identify the airway type: tracheostomy tube (note cuff and inner cannula) or laryngectomy stoma. Look for speech prostheses or HMEs obstructing the stoma. 2. Observe breathing: chest rise, stoma airflow, SpO2 and work of breathing. In laryngectomy patients there will be no airflow from mouth or nose. 3. Attempt to pass an appropriately sized...