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ENT > acute upper airway obstruction > Flashcards

acute upper airway obstruction Flashcards

1
Q

LOOK
LISTEN
FEEL

A

LOOK: skin color, trauma, swelling, infection, foreign bodies, chest and abdomen movement, acessory muscle use - tracheal tug, subcostal/intercostal recessoin, tripoding

LISTEN: breath sounds, gurgling, stridor, air entry, wheeze, crepitation

FEEL: feel at nose and mouth for exhaled air, chest movement, trachea for position, skin temp / clammy / sweaty

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2
Q

basic airway manourvers

A 
head tilt
chin lift
jaw thrust
suction
remove teeth
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3
Q

head tilt and chin lift

A

Aim is to open the airway
Stretches the submandibular tissues to pull the tongue forward and open the pharynx
Effective in supralaryngeal obstruction
Won’t work for obstruction at or below larynx
Evaluate effect after positioning

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4
Q

advantages and limitation s of using self inflated bag

A

Advantages:
Avoids direct person to person contact
Allows oxygen supplementation – up to 85%
Can be used with facemask, LMA, tracheal tube

Limitations:
When used with a facemask:
Risk of inadequate ventilation
Risk of gastric inflation 
Need two persons for optimal use
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5
Q

advanced airway manouvers

A

Intubation
Cricothyroid cannula
Tracheostomy
ECMO

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6
Q

needle cricothyroidotomy

A

Indication
Failure to provide an airway by any other means

Complications
Malposition of cannula
Emphysema
Haemorrhage
Oesophageal perforation
Hypoventilation
Barotrauma
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7
Q

3 causes of stridor

A

congenital
childhood acquired
adult acquired

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8
Q

congenital causes of stridor

A 
Laryngomalacia
Laryngeal Stenosis
Subglottic haemangioma
Vocal cord(s) paralysis
Laryngeal clefts
Laryngeal cyst
Vascular abnormalities
Rare tumours
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9
Q

laryngeal stenosis

A

second most common cause of stridor

supraglottic, glottic and subglottic web

associated with other midline congenital abnormalities

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10
Q

laryngomalacia (congenital floppy larynx)

A

commonest cause of non infective stridor

the arytenoids, epiglottis and aryepiglottic folds fall in on inspiration. presents day 1-2 of birth to 1 month and usually disappears by 2 years.

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11
Q

subglottic hemangioma

A

Present <6 months
50% have haemangiomata elsewhere (eg skin)

Radiograph shows soft tissue swelling confirmed at endoscopy

Regression in first 2 years is the rule but may enlarge before it regresses

Conservative approach is preferred but tracheostomy may be necessary in the neonatal period if airway is compromised

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12
Q

hemangioma

A

benign tumor of capillaries
most frequently occurs in the subglottis, usually solitory but may be multiple

50% of cases are associated with cervicofacial cutaenous haemangioma

stridor at 6 weeks

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13
Q

childhood acquired causes of stirdor

A 
Acute laryngo-tracheobronchitis
Acute epiglottitis
Foreign body ingestion
Obstructive sleep apnoea
Tumour
Metabolic
Iatrogenic
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14
Q

croup (acute laryngotracheobronchitis)

A

Commonest childhood infective cause of stridor

Tends to occur in epidemics in spring

Exclusively viral: influenza, para-influenza or respiratory syncitial virus

Inflamed larynx, trachea and bronchus

Presents initially with mild fever, runny nose progressing to sore throat, dysphagia and a dry irritating barking cough

Clinical diagnosis and conservative management
Some children need to be intubated and ventilated

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15
Q

acute epiglottitis

A

Rare specific infection by Haemophilus influenzae B (HIB vaccine)

Produces rapid oedema of the epiglottitis and aryepiglottic folds

Lethal airway obstruction can occur in hours

Toxic, septic child who drools saliva (unable to swallow)

Clinical diagnosis and treated in HDU with IV cefotaxime

60% needs intubation despite conservative management.

!!! Hazardous procedure only by Consultant Anaesthetists with ENT surgeon standby in theatre for emergency tracheostomy

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16
Q

how to treat stridor

A 
Calm Environment
Call for expert help ASAP
Keep sat up if possible
Nebulised Adrenaline
Bronchodilators and steroids
Call for expert help!
Only when patient collapses and arrests do anything else unless an expert
17
Q

foreign body

A

children put objects in mouth or nose.

BLS and ALS algorithm

rigid bronchoscopy under GA

18
Q

obstructive sleep apnoea

A

central or peripheral
(central is related to CNS disorder)

peripheral presents with day time somnolence and cyclic airway obstruction and apnoea

history and sleep study
adenoid and tonsils

manage with adenoidecotmy and tonsillectomy

19
Q

adult causes of stridor

A 
acute:
Aspiration of FB
Allergic oedema
Hereditary & acquired angiooedema
Trauma
Smoke & Fire
infection
non acute:
tumor
tracheal compression
neurological
rheumatological
OSA
20
Q

allergic oedema and anaphylaxis

A 
drugs, stings, nuts
atopic hx (IgE) e.g instect stings usually lead to glottic and pharyngeal oedema

IgG or direct complement activation (strawberry/nuts)

A-E
IM adrenaline 0.5-1mg
IV if severe CVS collapse
O2, fluid, position
hydrocortisone
antihistamine chlorampheniamine
bronchodilators
21
Q

hereditary and acquired angiodema

A

Secondary to reduced plasma C1esterase inhibitor

Hereditary: usually presents in infancy precipitated by local trauma (autodominant). ~30% die from asphyxia

Acquired: usually presents in adulthood associated with malignant/lymphoproliferative disease or the presence of autoantibodies to C1 esterase inhibitor

Treatment= supportive and C1 esterase inhibitor or FFP (has large amount of C4 & C2 which may worsen oedema)

22
Q

adult airway burns

A

Upper airway obstruction due to heat injury and mucosal swelling usually develops within 24 hours of exposure

Look for evidence of conjunctivitis, burnt nasal hair and soot deposit. May suggest pending airway obstruction

Is VITAL to recognise Early and seek appropriate intervention and monitoring

23
Q

laryngeal tumors

A

benign- papilloma, haemangioma, fibroma

malignant: 
Squamous cell carcinoma
adenocarcinoma
sarcoma
lymphoma
mucoepidermoid cancer
adenoid cystic carcinoma
24
Q

tumors

A

Papilloma – treated by immunotherapy and recurrent laser ablation under GA

Haemangioma as discussed before

Mediastinal tumour – lymphoma or T cell leukaemia. Extreme caution required. Most children should be treated with steroid prior to being subjected for a tissue biopsy for dx under GA (could be lethal)

Posttransplant lymphoproliferative disorder (PTLPD)- rare. Could be found in any lymphoid tissue in upper airway

25
Q

what is a papilloma

A

Characterised by single or multiple benign, non- keratinising squamous growths.
(Progressive/ persistent) hoarseness or aphonia and airway obstruction but with little stridor since the mass of papillomata is too soft to vibrate the air column.
Diagnosed via direct laryngoscopy and removed using a carbon dioxide laser.
Increase in oral cancers associated with HPV

26
Q

malignant tumors

A

most commonly squamous cell
50-60 y/o
smokers, alcohol

27
Q

glottic carcinoma

A

60% squamous cell carcinoma.

Prime symptom is hoarseness.

Other symptoms include earache, pain, chronic cough, dysphagia, neck lumps and dysphonia especially where spread has occurred.

Excellent prognosis with early diagnosis.

28
Q

supraglottic cancer

subglottic cancer

A

supraglottic: 30% squamous cell carcinoma.
Dysphonia.
May metastasize early particularly to upper cervical nodes.
Poorer prognosis due to late presentation and early spread.

subglottic: 10% malignant tumours. Produces less hoarseness but increasing airway obstruction
May be difficult to differentiate from chronic bronchitis or asthma.
Poorer prognosis due to late presentation and early spr ead.

29
Q

hoarse voice

A

examined by direct laryngoscopy
6 week hoarsness= emergency referral

CXR to exclude co-existent bronchial cancer

CT to determine extent of spread

FNA of lymph nodes

30
Q

tumors

A 
RT
total layngectomy
cyto-toxic chemo
tracheostomy
oesophageal speech / artificial larynx o tracheo oesophageal fistula
31
Q

vocal cord paralysis

A

Can be unilateral or bilateral; unilateral>bilateral

Birth trauma with neck and Recurrent Laryngeal Nerve (RLN) stretching may be a factor

Diagnosis made during endoscopy with patient breathing spontaneously to observe cords movement
Usually temporary and recovers within 4/52

32
Q

tracheal compression in adults

A

Thyroid enlargement, thoracic aortic aneurysm and mediastinal mass (neurofibroma), anterior mediastinal tumours or nodes

ENT (7 decks)

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