Airway Obstruction

Question 1

how does the larynx move on swallowing?

Answer 1

up and forward

allows food to pass into oesophagus

Question 2

what divides the upper and lower resp tract?

Answer 2

larynx

Question 3

where is the subglottis?

Answer 3

below the glottis (vocal cords together as a pair)

Question 4

describe the vocal cords in respiration vs phonation?

Answer 4

respiration = open
phonation = closed

Question 5

describe the special features of the respiratory system in neonates?

Answer 5

large head
small nares
obligate nasal breather (only breathe through nose to allow breastfeeding)
large tongue
small, soft larynx
higher position of larynx (C1)
weak neck muscles; floppy head
narrow subglottis (3.5mm at cricoid)

Question 6

what is the resistance to air flow equal to?

Answer 6

1/R to the power 4

- i.e a 2mm radius reduced by 1mm will produce a X16 increase in resistance and a 75% decrease in cross sectional area

Question 7

stridor vs stertor?

Answer 7

stridor = high pitched, harsh noise due to turbulent airflow resulting from airway obstruction
stertor = low pitched sonorous sound arising from nasopharyngeal airway

Question 8

signs of acute epiglottitis?

Answer 8

very breathless
drooling
cherry red epiglottis on investigation

Question 9

how is acute epiglottitis managed?

Answer 9

intubation

antibiotics

Question 10

what is the danger of inhaled foreign bodies?

Answer 10

very inflammatory

can quickly cause an infection or serious pneumonia

Question 11

effective management of laryngeal lymphoma?

Answer 11

high dose steroids

then normal cancer treatment

Question 12

how can HPV affect the larynx?

Answer 12

can cause recurrent respiratory papillomatosis

follicular growths on the larynx

Question 13

what is subglottic stenosis?

Answer 13

narrowing of the vocal cords
can be congenital (rare)
can be inflammatory (e.g after long period of intubation/ventilation)

Question 14

how can burns affect the airway?

Answer 14

inhalation can cause the larynx to melt

swelling

Question 15

3 components of assessment of airway?

Answer 15

appearance
work of breathing
skin circulation

Question 16

how can respiratory problems present in infants?

Answer 16

recession in the chest
air in the abdomen
discomfort and swelling visible in the face

Question 17

how can respiratory problems progress in infants?

Answer 17

respiratory distress > respiratory failure > cardiovascular failure > neurological failure (brain damage, irreversible)

Question 18

general management of airway obstruction?

Answer 18

ABCDE - resuscitation
oxygen
heliox (oxygen and helium)
steroid
adrenaline
flexible fibre-optic endoscopy
secure airway with ET tube/tracheostomy
treat underlying pathology

Question 19

how is an airway endoscopy performed?

Answer 19

rigid vs flexible
examination without the ET tube in is the best option
general anaesthetic given
medications given to assist breathing during
- heliox
- budesonide nebuliser
- dexamethasone
- adrenaline nebuliser

Question 20

what are the 4 options for methods of airway endoscopy?

Answer 20

direct laryngoscopy
microlaryngoscopy
examination with Hopkins rods
laryngoTracheoBronchoscopy

Question 21

how often is tracheostomy performed?

Answer 21

last resort

should be avoided at all possibilities