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����Rescue Breathing For Laryngectomees and Other Neck Breathers

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Itzhak Brook MD, MSc.�Professor of Pediatrics and Medicine�Georgetown University School of Medicine

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Aim

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  • Needs of laryngectomees and other neck breathers (NB)
  • Distinguish between total NB and partial NB
  • Describe rescue breathing for both
  • Lary’s Communication methods
  • Use of appropriate equipment in basic life support (BLS)

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National Cancer Institute findings

  • ~ 12,250 diagnosed with laryngeal cancer annually
  • 4 of 5 are males
  • 77% will be 55 y/o and older.
  • In 2005 there were 93,096 U.S. patients
  • Main causes: smoking, alcohol, Papilloma virus (HPV)

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Treatment

Radiation

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Chemotherapy

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Surgery

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Laryngectomees

  • Most had laryngectomy because of cancer.
  • May have other medical problems due to cancer, treatment, radiation, age.
  • Call 911: difficulty in breathing (mucus plug, airway blockage)
  • Many get inappropriate treatment by EMTs and in ER.

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laryngectomees

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  • ~50 000 cases in USA
  • Breathe ONLY through a stoma
  • No air passes through the nose or mouth
  • May have trouble speaking

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Stoma Covers

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Foam Stoma Cover

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Ascot

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Communication Methods

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  • Writting
  • Silent articulation
  • Sign language
  • Three speaking methods

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Speaking Methods

  • Esophageal voice
  • Voice prosthesis through tracheo-esophageal fistula (TEP)
  • Electronic larynx (artificial larynx device)

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  • Esophageal Voice

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Esophageal Speech

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  • Voice Prosthesis (through tracheo-esophageal fistula)

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Tracheostomy site (stoma)�

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�Tracheostomy site with housing and with a filter (Heat and moisture exchange system or HME) �

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Voice prosthesis.

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A Heat Moisture Exchange (HME) Filter and Tracheo-esophageal Voice Prosthesis

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Hands free HME

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A Flushing bulbs for a Voice Prosthesis

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Hands free HME in housing

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  • Electronic Larynx (artificial larynx device)

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Electro-Larynx Devices

       

         

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Partial Neck Breather

  • Breathing through stoma
  • There is a connection between the lungs and the nose, and mouth
  • The extent of breathing through nose and mouth varies
  • A tracheostomy tube is generally present

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Laryngectomy and Tracheostomy

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Partial Neck Breather�(Ventilate through stoma & occlude nose and mouth)

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  • Failure to recognize the exact condition can lead to inappropriate treatment

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Medic-Alert Bracelet and Card

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Rescue of a neck breather (1)

  • Determine unresponsiveness
  • Activate emergency medical services
  • Position the person
  • Expose neck
  • Remove anything covering the stoma (filter, cloth)
  • Clear mucous, raise shoulders

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Rescue of a neck breather (2)

  • Do NOT remove stoma’s housing unless blocking airway
  • Do NOT remove voice prosthesis
  • Trach tube (outer & inner) may need to be removed to clear plugs ( use saline “bullets”)
  • If prosthesis is dislodged replace it with a catheter (prevents aspiration & fistula closure)
  • Breathing ?(look, listen and feel over stoma)
  • Wipe and suction

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Laryngectomy and Tracheostomy CPR (1)

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  • Perform CPR as usual.
  • Ventilate through stoma (mouth to stoma) or use mask (infant/toddler or adult turned through 900)
  • Use a special tracheostomy tube (shorter) to intubate
  • If breathing normally treat as unconscious patient

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Laryngectomy and Tracheostomy CPR (2)

  • Useless to try mouth-to-mouth!
  • Often difficult to detect neck pulse (radiation fibrosis)
  • Many only have one radial artery (if used for free flap)
  • The chest may fail to rise because tracheostomy tube blocked
  • Air escapes from mouth & nose in partial neck breather (need to seal)

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Oxygen Administration Mask

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Infant Mask Used In Rescue Breathing of Neck Breathers

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Other issues

  • Ability to communicate may be impaired
  • Allow laryngectomees to write their messages & use flash cards
  • Deliver humidified oxygen

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Summary

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  • Administer 02 and ventilate through stoma

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  • In partial neck breathers

seal mouth and nose

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  • Use child mask or adult turned through 900

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Thanks for your attention!��Any Questions?

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Itzhak Brook MD

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ib6@georgetown.edu�

Phone: 202-744 8211

Blog site: http://dribrook.blogspot.com/  

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