New York State Basic Emergency Medical Technician (EMT-B) Practice Exam

Which one of the following instructions applies to the performance of mask-to-stoma ventilation on a person who has had a COMPLETE laryngectomy?

1. The nose and mouth must be manually sealed off

2. Perform head tilt neck lift maneuver to open the airway

3. The nose must be sealed off

4. Neither the nose nor mouth must be sealed off

The correct answer is: Neither the nose nor mouth must be sealed off

When performing mask-to-stoma ventilation on a person who has had a complete laryngectomy, it is essential to understand the anatomy and physiology of the airway after such a surgical procedure. A complete laryngectomy involves the removal of the larynx, which includes the vocal cords and the associated structures responsible for normal breathing and voice production. In this case, the airway is diverted to a stoma, which is an opening in the neck created during the surgery. Sealing the nose and mouth is not necessary in this situation because the respiratory system's access is solely through the stoma. The stoma serves as the patient's airway, and air should flow freely in and out of it for effective ventilation. Therefore, neither sealing the nose nor the mouth is appropriate as it may obstruct airflow and create complications. In contrast, efforts to perform a head tilt-neck lift maneuver are redundant because the direct passage to the lungs is through the stoma, and there is no need for traditional maneuvers used in cases of intact airways. Understanding this unique airway setup is crucial for providing effective ventilation and ensuring the safety of the patient during emergency care.