# CPR Question regarding Laryngectomy



## shannabug24 (Feb 15, 2011)

Hello All! I am a student and my instructor has given the class a homework assignment to ask around to see if anyone knows the answer to a question. The question is....If you are a cpr instructor and you are teaching a student who has had a total laryngectomy how would you teach him to give breaths to an unresponsive patient WITHOUT using any equipment?? The instructor insists that this can be done. Any Ideas?? Please let me know thanks!


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## Shishkabob (Feb 15, 2011)

I WOULDN"T instruct someone to give ventilations without equipment.


Compressions only CPR without proper equipment.


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## NREMTroe (Feb 15, 2011)

Linuss said:


> I WOULDN"T instruct someone to give ventilations without equipment.
> 
> 
> Compressions only CPR without proper equipment.



I agree. The only logical way I see here, is to do compression only CPR


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## Journey (Feb 15, 2011)

For willing family members, we teach mouth to stoma during their discharge CPR class. But, we usually send home a BVM with an infant or pedi mask that fits over the stoma with the patient. This is usually the same set up you will find in nursing homes or at the bedside in hospitals along with appropriate tube.

 If they have an laryngectomy tube, it probably will not have a 15 mm adaptor and will need to either have the adaptor inserted or the tube changed. Some patients may also have a valve used to facilitate speech between their trachea and esophagus which can become dislodged. The fistula may be open to where stomach contents can enter the trachea or cause gastric insufflation. 

 A pediatric patient, usually in a chronic vegetative state, who has had a permanent opening made to prevent aspiration  with the trachea brought forward to make the stoma opening, same as in adults, will probably not have a fistula between the esophagus and trachea to be concerned about.


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## Aidey (Feb 15, 2011)

^^^ In this scenario the person performing CPR is the one with the laryngectomy.


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## Journey (Feb 15, 2011)

Aidey said:


> ^^^ In this scenario the person performing CPR is the one with the laryngectomy.



What scenario are you referring to?  

A person who has a laryngectomy could perform chest compressions but they would be at a disadvantage for doing mouth to mouth on their loved ones. For those not familar with laryngectomy patients, the upper airway is no longer connected to the lower airway. The trachea is disconnected where the larynx had been and is brought to the surface to form the stoma. Thus, the term "neck-breathers" is sometimes used to describe these patients. It is of no use to give O2 or attempt to ventilate by the nose or mouth of these patients. 

 We have had a couple of situations like that where we were teaching the grandparents CPR who were the babysitters for an at risk child and the grandmother had a laryngectomy. However, she learned to use a BVM better than some anesthesiologists. When it is someone close to you, a little more effort and creativity goes into doing what needs to be done.


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## Aidey (Feb 15, 2011)

The scenario in the question the OP asked. 



shannabug24 said:


> Hello All! I am a student and my instructor  has given the class a homework assignment to ask around to see if anyone  knows the answer to a question. The question is....If you are a cpr  instructor and _*you are teaching a student who has had a total  laryngectomy*_ how would you teach him to give breaths to an unresponsive  patient WITHOUT using any equipment?? The instructor insists that this  can be done. Any Ideas?? Please let me know thanks!


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## Journey (Feb 15, 2011)

I guess some of that would depend on their stoma opening and what tubes they have available. Like I stated before, people can get creative, especially those with long term medical problems.


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## PHRNJAK (Feb 23, 2011)

*my thoughts*

The CPR student with laryngectomy would have to use a BVM to deliver breaths. They are able to pass CPR and become certified as long as they meet all other requirements and effectively deliver breaths using the BVM. I guess if CPR was a job requirement then that person would have to have access to a BVM at all times. 

without equipment, the student would only be able to do compressions


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