Emergency Laryngectomy Management – the ‘Red’ Algorithm

The management of patients with a laryngectomy differs to that of those with a tracheostomy, due to the anatomical differences between the two. As there is no continuity between the oropharynx and the trachea, the patient cannot be oxygenated via the mouth or nose.

If there is any uncertainty as to whether the patient has had a laryngectomy, oxygen should be delivered to the face and stoma or tracheostomy tube until this can be determined.

The Red algorithm for patients with a laryngectomy³ differs to the Green algorithm in the following ways;

• Oxygen to the mouth or nose is of no benefit and is therefore omitted.
• Primary emergency oxygenation omits the use of oral airway adjuncts, facial oxygenation and ventilation, and focusses solely on oxygenation via the stoma site.
• Secondary emergency oxygenation intubation is at the stoma site.

Laryngectomy patients may well present without a tracheostomy tube in situ, resulting in faster progression through the algorithm and earlier attempts at emergency oxygenation

The Red algorithm is shown below and can be found on the NTSP website here.

Learning bite

If there is any uncertainty as to whether the patient has had a laryngectomy, oxygen should be delivered to the face and stoma or tracheostomy tube until this can be determined.