How do I know the patient is a laryngectomee?
A laryngectomee may not be immediately apparent. Warning signs are the presence of a neck covering of some sort — perhaps a cravat or a scarf. Many laryngectomees wear a Medic Alert bracelet or necklace to draw attention to their unique needs. Once the clothing around the neck is loosened and the throat exposed, the stoma — the hole in the neck — makes it obvious the patient needs special care.
What difference in approach is needed?
It is vital to remember that a Laryngectomee’s nose and mouth DO NOT CONNECT to their lungs. Resuscitation through the mouth or nose is impossible. For air to reach the lungs, it must pass through the stoma (hole) situated at the base of the neck under the chin. Once the stoma is exposed, check for several possible signs.
Several possible signs
- If you can see the hole (stoma), commence mouth to stoma resuscitation.
- If a narrow white silicone strap (about 5mm to 6mm wide and 1 to 1.5cm long ) protrudes from the hole, leave it alone. Under no circumstances should it be removed; it is a part of the internal valve between the windpipe and the oesophagus that must remain in place to prevent food or liquid from entering the lungs. Commence resuscitation with everything left in place.
- As well as the internal valve, some laryngectomees wear an external valve. It is in two parts and easily recognisable – a circular silicone base plate with a hole in the middle, sitting immediately over the stoma, and a circular plastic button about 3 cm in diameter, fitted into the baseplate hole. Remove the plastic button by pulling it firmly out of the base plate. The baseplate can remain in place; if you remove it, you will not harm the patient. Commence resuscitation.
- Remember, a laryngectomee uses a different method of speech. If injured, or if the voice aid is lost, communication may be affected.