10.2 Conditions Involving The Larynx And Airway Management Flashcards
Give examples of conditions that affect the larynx
Laryngitis Laryngeal nodules Laryngeal cancer Laryngeal oedema Epiglottitis Croup
What is laryngitis?
Inflammation of the larynx, often involving the vocal cords ( become oedematous and less pliable)
How is laryngitis diagnosed?
Clinical history
How does laryngitis present?
Hoarse / weak voice and sore throat
History of URTI
What causes laryngitis?
Viral infection ( rhinovirus, influenza, adenovirus, coronavirus) Non- infectious aetiology ( irritating substances, overusing voice)
How is laryngitis treated?
Self-limiting - fully resolves in 2-3 weeks
What causes laryngeal nodules?
Acute trauma
Chronic irritation of vocal cords
What are laryngeal nodules?
Benign growths on the vocal folds
How do laryngeal nodules present?
Hoarseness of voice ( longer than 3 weeks)
How are laryngeal nodules treated?
Visualisation of cords (laryngoscope/nasal endoscopy)
Biopsy to exclude laryngeal cancer
What is stridor?
A harsh, shrill grating sound on inspiration or expiration.
Usually due to upper respiratory tract pathology
How will a patient with a compromised upper airway present?
Stridor Raised respiratory rate Distress Hypoxia Cyanosis
What causes laryngeal oedema?
Allergic reaction (anaphylaxis) swallowed foreign body
What is epiglottitis?
Inflammation usually secondary to infection. Causes swelling of epiglottis and supraglottis tissues.
Why is epiglottitis a medical emergency?
Rapid swelling can cause immediate threat to airway
Who is likely to present with epiglottitis?
Children/ infants
How might epiglottitis present?
Stridor Difficulty breathing Difficulty swallowing Pooling as saliva pools in mouth Fever Sat in Sniffing position
What is sniffing position?
Head extended at neck to maintain airway patency
What is epiglottitis usually caused by?
Bacterial infection - haemophilus influenzae
How is epiglottitis usually treated?
Secure airway (intubation/tracheostomy) Antibiotics
What is croup?
Inflammation of the larynx in children
How does an infant with croup present?
Characteristic barking cough
Symptoms worsen with agitation
Stridor
Who is typically affected by croup?
Children/infants (6months to 3 years)
How is croup usually treated?
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
What are the protective reflexes involved in protecting the airways?
Gag
Cough
Swallow
Why are the airways at risk in decreased consciousness?
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
What are the 2 broad categories of airway management?
Planned
Emergency
Why might we plan to manage an airway?
In preparation for surgery involving general anaesthetic
Why might emergency airway management be necessary?
acute/immediate threat to airway
conscious = laryngeal oedema/occlusion of airway
unconscious patient = cardiac arrest
What are simple manoeuvres used to open up the airway?
Head tilt
Chin lift
When is a head tilt/chin lift used?
Emergency airway management - unconscious/cardiac arrest
When putting in endotracheal tube
What are airway adjuncts?
Devices used to support simple airway manoeuvre and maintain patent upper airway.
What are the 2 airway adjuncts used?
Oropharyngeal airway ( guedel) Nasopharyngeal airway
What are the disadvantages of using airway adjuncts?
Dont protect lower respiratory tract from vomit/secretions
Oropharyngeal airway can illicit gag reflex if minimal depression of consciousness
IGel is an example of what?
A supraglottic airway
What is a supraglottic airway used for?
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
What is an example of a definitive airway?
Intubation
What is intubation
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.
What is the advantages of intubation?
Can be used long term for airway management as secures and protects (vomit/secretions) lower respiratory tract
Why is intubation more complicated than a supraglottic airway ?
Requires used of laryngoscope
Technical skill
Patient needs to be anaesthetised before insertion
What is a laryngoscope?
A device used to visualise the larynx. Inserted into oral cavity. Curved ‘blade’ with torch on the end. Sits in the vallecular
When inserting a endotracheal tube, when structures does the tube pass through?
Oral cavity
Oropharynx
Laryngeal inlet
Glottis
What is the endotracheal tube connected to?
Ambu bag
Ventilator
What is the name of the 2 airway adjuncts?
Orophryngeal airway
Nasopharyngeal airway
What is the role of airway adjuncts
To keep the tongue and tissues of the larynx off of the oropharynx. Keeps airway patent
In terms of placement how does a supraglottic airway from an ET tube?
Supraglottic surrounds the laryngeal Tube sits at the top of the trachea.
