10.2 Conditions Affecting the Larynx Flashcards
What are 3 conditions affecting the larynx that have no immediate threat to the airway?
- Laryngitis
- Laryngeal nodules
- Laryngeal cancer
What is laryngitis?
Inflammation of the larynx involving TVCs
- Diagnosed from history
- Usually following URTI
- Typically viral
- Can be from repeated abrasion such as singing
- Self-limiting, fully resolves in 2-3 weeks, take OTC medication, paracetamol
What are laryngeal nodules?
Small, benign growths on TVC
What causes laryngeal nodules and how does it present?
Acute trauma or chronic irritation
Presents with hoarseness of voice >3weeks
Requires visualisation of cords to rule out laryngeal cancer +/- biopsy
What does Laryngeal cancer look like?
Small white nodules on the TVC
What conditions affecting the larynx cause swelling that can present an immediate threat to the airway?
Laryngeal Oedema
Epilottitis
Croup
What causes laryngeal oedema?
Anaphylaxis
Swallowed foreign body
What causes epiglottitis?
-Usually Haemophilus Influenzae B, rare due to HIb vaccination
-Usuaully in children 2-6, stridor, difficulty breathing, swallowing (may dribble), high fever, sore throat and sitting up in ‘sniffing position’
-DO NOT EXAMINE AS EPIGLOTTIS MAY SNAP SHUT refer to ENT for intubation
What is the sniffing position?
Nose pointing upwards, lifts tissues off larynx to help breathing
How do you treat epiglottitis?
Antibiotics after intubation (if needed)
What is croup? (Acute laryngotracheobronchitis)
- Usually viral, parainfluenza virus, affecting larynx and trachea
- Common in 6 months to 3 years
- Barking cough made worse on agitation and at night
- Stridor can also occur when upset and cyanosis
How do you treat croup?
-Dealt with at home, give single dose corticosteroid, calm them down and sit them up
-If respiratory distress or stridor, give nebulised oxygen and adrenaline with corticosteroids
How does a patient with a compromised upper airway present?
Stridor
Raised respiratory rate
Distress
Hypoxia
+/- Cyanosis
Why is airway management crucial?
Hypoxia kills
What normally holds the airway open?
General tone in muscles of upper pharynx,larynx, tongue
What are 3 protective reflexes of the airway?
Gag
Cough
Swallow
What can cause the airway to be at risk?
Decreased concious levels cause decreased tone and suppression of reflexes
How can the airway be managed?
Planned- preparation for surgery involving general anaesthetic
Emergency- acute/immediate threat to airway- concious e.g. laryngeal oedema/ unconscious patient e.g. cardiac arrest
What is Ludwig’s Angina?
Infection of the floor of the oral cavity, swelling of the floor, pushes tongue upwards and compromises the airways
What are 2 simple airway manoeuvres?
Head tilt
Chin tilt
No protection of LRT, vomit/secretions as airway held open
What else can we use to open the airway?
Airway adjuncts
-Oropharyngeal airway (Guedel) (don’t use if semi-conscious, causes gag reflex)
-Nasopharyngeal airway
Allows for spontaneous ventilation, offers no protection of LRT
Both hold the tongue down
When do you use airway adjuncts or simple airway manoeuvres?
When the patient is able to breathe spontaneously
What do you use if airway adjuncts don’t work?
Supraglottic airway e.g. iGel
What is a supraglottic airway?
iGel, forms cuff around laryngeal inlet, moulds to the anatomy as it becomes warm inside the body
* Maintains airway
* Minimal technical skills needed
* First line in cardiac arrest
* Not for long-term ventilation e.g. ITU
What is the definitive airway?
Intubation- Absolute gold standard for most airway compromisations
* Insert laryngoscope into valecula
* Insert endotracheal tube through oral cavity on top of laryngoscope into the laryngeal inlet
* Protects LRT from secretions/vomit
* Requires technical skill need to visualise the vocal cords from behind
When is intubation performed?
If patient is not in cardiac arrest, anaesthetised prior to insertion
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