Acute upper airway obstruction

Question 1

Signs of partial

Answer 1

Stridor
+WOB->retraction, accessory muscle use

If severe obstruction->may have signs of hypoxia

Question 2

Signs of deterioration and indications for urgent itervention

Answer 2

Hypoxia->worried, restless, irritable
Fatigue, negative LOC
++WOB

Question 3

Assessment of common causes

Answer 3

1. A harsh, barking cough in a febrile, miserable, but otherwise well child suggests croup
2. Absent cough with low pitched expiratory stridor (often snoring) and drooling suggests epiglottitis.
3. Sudden onset in an otherwise well child with coughing, choking and aphonia suggests an inhaled foreign body
4. Swelling of face and tongue, wheeze or urticarial rash suggests anaphylaxis

Question 4

High fever, hyper-extension of neck, dysphagia, pooling of secretion in mouth

Answer 4

Retropharyngeal/peritonsillar abscess

Question 5

Toxic appearing, markedly tender trachea

Answer 5

Bacterial tracheitis

Question 6

Pre-existing stridor

Answer 6

Congenial->floppy trachea, hemangioma, supraglottic stenosis
Pharyngeal cysts
Vocal cord palsy
Laryngeal papilloma
Vascular rings

Question 7

Management

Answer 7

Minimal handling->Allow child to sit quietly in carers lap in their most comfortable position
Observe with minimal interference->don’t change their position
Don’t look in throat/ears->do not want to upset them
Treat specific cause
Call PICU if severe, if worsening
Oxygen may be given, while awaiting definitive treatment
Should defer IV->upsetting may further obstruct

Question 8

Should lateral soft tissue xrays be done

Answer 8

Do not assist in management

In severe, xray can delay

Question 9

ETT tube in acute upper airway obstruction neonate, 5

Answer 9

Neonate 2.5 - 3 mm
5 yr 1/2 to 1 size smaller than usual

(usual size (mm) = 4 + age/4)

Question 10

Emergency relief of totally obstructed airway

Answer 10

Adequate oxygenation->14 guage IV cannula through cricothyroid membrane
Patient lying straight, cannula midline angled towards feet
Remove need from cannula, connect cannula to resuscitator bagging circuit
100% oxygen
Can connect to wall source of oxygen with three way tap to allow expiration and plastic tubing. A plastic tube with a side hole can be used
Lateral chest compressions to aid intermittent expiration

Alternative: cricothyroidotomy->midline, cricothyroid membrane, blunt dissection, insert small tracheostomy or ETT

Question 11

Bacterial tracheitis

Answer 11

Toxic
Tender trachea
S. Aureus
Direct visualisation
Need ETT
ICU care

Question 12

Retropharyngeal/peritonsillar presentation

Answer 12

Fever
Dysphagia
Drooling
Unwilling to move neck
Hyper-extended

Polymicrobial

Question 13

Management of retropharyngeal abscess

Answer 13

Airway compromise

1. IV dexamthasone and nebulised adrenalin
2. Surgery
3. Antibiotics: ampicillin or ceftriaxone
4. Supportive and analgesia