What should you do for a 64-year-old woman with a complete laryngectomy who is in respiratory arrest?

For a 64-year-old woman with a complete laryngectomy who is in respiratory arrest, suctioning the stoma is the most appropriate immediate action. In cases of complete laryngectomy, the airway is redirected out of the stoma (the surgical opening created in the neck), and normal bag-mask ventilation through the mouth and nose is not effective. Therefore, suctioning the stoma helps to clear any obstruction and ensure that air can flow effectively through the stoma to provide any necessary ventilation.

This action addresses the specific anatomical changes that occur after a laryngectomy, as the patient's airway is now separated from the oral cavity and the standard airway management techniques used for patients with an intact airway do not apply to her situation. Suctioning can also help to remove any secretions that may be blocking the airway, which is particularly important in a patient who is not breathing and may have accumulated secretions.

While performing CPR might be indicated in cases of cardiac arrest, the primary focus in respiratory arrest caused by airway obstruction in a patient with a laryngectomy is to ensure the stoma is clear. Using a nebulizer is not suitable since it requires an intact respiratory tree to deliver medication effectively, which is not applicable here.