Airway Obstruction

Question 1

Where is the barrier between the upper and lower airway?

Answer 1

The vocal cords:
anything above; upper.
anything below; lower

Question 2

Which airway (nose or mouth) is the primary airway and which is the secondary airway? Explain the need for a secondary airway.

Answer 2

Nose = primary
Mouth = secondary
Secondary airway is there so if nose becomes blocked/sleeping there is the ability to breathe still, sort of like a failsafe mechanism.

Question 3

The nose functions to ____ and ____ air.

Answer 3

Humidify and warm air

Question 4

The larynx is the junction between the upper and lower airways and is made up of ____ and ____

Answer 4

Cartilages and ligaments

Question 5

Below the vocal cords lies the _____

Answer 5

Sub-glottis and cricoid cartilage

Question 6

The vocal cords vibrate to produce sounds - true/false

Answer 6

False - they in themselves do not vibrate; they obstruct the airflow to allow the air to vibrate and produce sound.

Question 7

When speaking the vocal cords ABduct/ADduct and while breathing they will ABduct/ADduct. explain why these two movements happen.

Answer 7

Vocal cords ADduct during speaking to obstruct the airflow and create turbulence.
the vocal cords ABduct during breathing to allow the air to pass freely between the upper and lower airways.

Question 8

Very young children have a large head, small nasal cavities and are obligate mouth breathers; they cannot breathe through their nose - true/false

Answer 8

False - they have a large head, small nasal cavities but are obligate nasal breathers.

Question 9

Kids have a relatively large tongue and a small, soft larynx which lies higher/lower at C1/C7. How does this compare to adults?

Answer 9

Relatively large tongue, small soft larynx, lies higher at C1. Compares to adults in that it is higher as adults normally have a larynx lying between C3-C6.

Question 10

There are 8 potential causes of airway obstruction - name 4 of the 8

Answer 10

Any four from:

1. Inflammatory/infective/allergic
2. Foreign bodies (kids espec.)
3. Physical compression/invasion
4. Trauma/iatrogenic
5. Neurological causes
6. neoplastic causes
7. Burns
8. Congenital airway pathology

Question 11

examples of an infective inflammatory cause include:
1.
2.

Answer 11

1. Huge tonsils or adenoids with Obstructive sleep apnoea

2. Epiglottis

Question 12

Why is airway obstruction due to epiglottis vanishingly rare?

Answer 12

Introduction of the HiB vaccine.

Question 13

Blunt trauma can cause an airway obstruction - how?

Answer 13

Laceration can give a clean cut across the airway or something could compress/collapse the airway

Question 14

What is the most important thing to do when suspecting inhalation burns?

Answer 14

Intubate immediately. A burned airway needs to be intubated right away as there is an increased risk of the air way collapsing and you want to get it tube before it does.

Question 15

How do you assess and manage an obstructed airway?

Answer 15

ABCDE.
look/listen/feel for breath, can they talk to you?
assessing rhythm and rate. give oxygen or helix. give steroids and adrenaline to suppress any inflammation and dilate the airway. Consider a flexible endoscopy of the URT and secure their airway with an ET tube if necessary and if you can’t manage this call anaesthetics and consider tracheostomy.
Treat underlying pathology to resolve the obstruction.

Question 16

tracheostomy should be avoided at all costs in children - true/false. If true, why?

Answer 16

True unless no other choices

High risk of morbidity and mortality and there are deaths associated later in life with it.