10.2 Conditions Involving The Larynx And Airway Management

Question 1

Give examples of conditions that affect the larynx

Answer 1

Laryngitis
Laryngeal nodules
Laryngeal cancer
Laryngeal oedema
Epiglottitis
Croup

Question 2

What is laryngitis?

Answer 2

Inflammation of the larynx, often involving the vocal cords ( become oedematous and less pliable)

Question 3

How is laryngitis diagnosed?

Answer 3

Clinical history

Question 4

How does laryngitis present?

Answer 4

Hoarse / weak voice and sore throat

History of URTI

Question 5

What causes laryngitis?

Answer 5

Viral infection ( rhinovirus, influenza, adenovirus, coronavirus)
Non- infectious aetiology ( irritating substances, overusing voice)

Question 6

How is laryngitis treated?

Answer 6

Self-limiting - fully resolves in 2-3 weeks

Question 7

What causes laryngeal nodules?

Answer 7

Acute trauma

Chronic irritation of vocal cords

Question 8

What are laryngeal nodules?

Answer 8

Benign growths on the vocal folds

Question 9

How do laryngeal nodules present?

Answer 9

Hoarseness of voice ( longer than 3 weeks)

Question 10

How are laryngeal nodules treated?

Answer 10

Visualisation of cords (laryngoscope/nasal endoscopy)

Biopsy to exclude laryngeal cancer

Question 11

What is stridor?

Answer 11

A harsh, shrill grating sound on inspiration or expiration.

Usually due to upper respiratory tract pathology

Question 12

How will a patient with a compromised upper airway present?

Answer 12

Stridor
Raised respiratory rate
Distress
Hypoxia
Cyanosis

Question 13

What causes laryngeal oedema?

Answer 13

Allergic reaction (anaphylaxis)
swallowed foreign body

Question 14

What is epiglottitis?

Answer 14

Inflammation usually secondary to infection. Causes swelling of epiglottis and supraglottis tissues.

Question 15

Why is epiglottitis a medical emergency?

Answer 15

Rapid swelling can cause immediate threat to airway

Question 16

Who is likely to present with epiglottitis?

Answer 16

Children/ infants

Question 17

How might epiglottitis present?

Answer 17

Stridor
Difficulty breathing
Difficulty swallowing
Pooling as saliva pools in mouth
Fever
Sat in Sniffing position

Question 18

What is sniffing position?

Answer 18

Head extended at neck to maintain airway patency

Question 19

What is epiglottitis usually caused by?

Answer 19

Bacterial infection - haemophilus influenzae

Question 20

How is epiglottitis usually treated?

Answer 20

Secure airway (intubation/tracheostomy) 
Antibiotics

Question 21

What is croup?

Answer 21

Inflammation of the larynx in children

Question 22

How does an infant with croup present?

Answer 22

Characteristic barking cough
Symptoms worsen with agitation
Stridor

Question 23

Who is typically affected by croup?

Answer 23

Children/infants (6months to 3 years)

Question 24

How is croup usually treated?

Answer 24

Usually managed at home with single does of corticosteroid medication (dexamethosone/prednisolone)

Severe - emergency intervention, nebulised adrenaline and oxygen, course of corticosteroids to reduce inflammation

Question 25

What are the protective reflexes involved in protecting the airways?

Answer 25

Gag Cough Swallow

Question 26

Why are the airways at risk in decreased consciousness?

Answer 26

As there is decreased tone and suppression of reflexes In supine position the tissues surrounding the airways have a tendency to fall back, occluding the air from entering from the nasopharynx/oropharynx

Question 27

What are the 2 broad categories of airway management?

Answer 27

Planned | Emergency

Question 28

Why might we plan to manage an airway?

Answer 28

In preparation for surgery involving general anaesthetic

Question 29

Why might emergency airway management be necessary?

Answer 29

acute/immediate threat to airway conscious = laryngeal oedema/occlusion of airway unconscious patient = cardiac arrest

Question 30

What are simple manoeuvres used to open up the airway?

Answer 30

Head tilt | Chin lift

Question 31

When is a head tilt/chin lift used?

Answer 31

Emergency airway management - unconscious/cardiac arrest | When putting in endotracheal tube

Question 32

What are airway adjuncts?

Answer 32

Devices used to support simple airway manoeuvre and maintain patent upper airway.

Question 33

What are the 2 airway adjuncts used?

Answer 33

``` Oropharyngeal airway ( guedel) Nasopharyngeal airway ```

Question 34

What are the disadvantages of using airway adjuncts?

Answer 34

Dont protect lower respiratory tract from vomit/secretions | Oropharyngeal airway can illicit gag reflex if minimal depression of consciousness

Question 35

IGel is an example of what?

Answer 35

A supraglottic airway

Question 36

What is a supraglottic airway used for?

Answer 36

To secure the airway. Maintains airway and provides some protection for the lower respiratory tract Often first line in cardiac arrest NOT used for long-term ventilation such as in ITU

Question 37

What is an example of a definitive airway?

Answer 37

Intubation

Question 38

What is intubation

Answer 38

When an endotrachel tube is placed through the oral cavity, through the oropharynx, through larynx and into the trachea. Cuff is inflated at the end of the endotracheal tube to secure in the trachea.

Question 39

What is the advantages of intubation?

Answer 39

Can be used long term for airway management as secures and protects (vomit/secretions) lower respiratory tract

Question 40

Why is intubation more complicated than a supraglottic airway ?

Answer 40

Requires used of laryngoscope Technical skill Patient needs to be anaesthetised before insertion

Question 41

What is a laryngoscope?

Answer 41

A device used to visualise the larynx. Inserted into oral cavity. Curved ‘blade’ with torch on the end. Sits in the vallecular

Question 42

When inserting a endotracheal tube, when structures does the tube pass through?

Answer 42

Oral cavity Oropharynx Laryngeal inlet Glottis

Question 43

What is the endotracheal tube connected to?

Answer 43

Ambu bag | Ventilator

Question 44

What is the name of the 2 airway adjuncts?

Answer 44

Orophryngeal airway | Nasopharyngeal airway

Question 45

What is the role of airway adjuncts

Answer 45

To keep the tongue and tissues of the larynx off of the oropharynx. Keeps airway patent

Question 46

In terms of placement how does a supraglottic airway from an ET tube?

Answer 46

Supraglottic surrounds the laryngeal Tube sits at the top of the trachea.