Airway obstruction

Question 1

special airway features of neonates and babies:

Answer 1

Large head
Small Nares
Neonates are obligate nasal breather
Relatively large tongue
Small, soft larynx
Higher position (C1)
Weak neck muscles; floppy head
Narrow subglottis (3.5 mm at the cricoid)

Question 2

what is the equation for the relationship between airflow resistance and radius?

Answer 2

air flow resistance is directly proportional to 1/r^2

as the radius becomes smaller there is an exponential increase in air flow resistance - breathing difficulty

can be progressive with tumors

Question 3

what are the causes of airway obstruction?

Answer 3

Inflammatory/Infective causes /Allergy
Foreign bodies 
Physical compression/invasion of airway 
Trauma/Iatrogenic Trauma
Neurological causes
Neoplastic causes 
Burn
Congenital airway pathology

Question 4

what are the signs and symptoms seen in airway obstruction?

Answer 4

SOB on Exertion
SOB at rest Stertor/Stridor
Coughing
Choking
Inability to complete a sentence
Sternal/Subcostal recession
Tracheal tug
Dusky skin colour of skin
Dysphagia
Dysphonia
Pyrexia
Cyanosis
stridor 
stertor

Question 5

what is stridor?

Answer 5

High pitched harsh noise due to turbulent airflow resulting from airway obstructions
worrying symptom

Question 6

what is stertor?

Answer 6

Low pitched sonorous sound arising from nasopharyngeal airway, lots of bass into the sound, usually with adenoids are swollen. No reason to be worried

Question 7

what is seen in children with sleep apnea?

Answer 7

huge tonsils and adenoids

Question 8

what color is the airway in acute epiglottis?

Answer 8

cherry red

Question 9

acute epiglottis:

Answer 9

decrease in infection these days

Question 10

foreign bodies as a cause of airway obstruction:

Answer 10

Organic stuff are extremely inflammatory and can close of one side of the bronchus and give pneumonia

Question 11

is malignant pathology a cause of airway obstruction?

Answer 11

yes

Question 12

recurrent respiratory papillomatosis:

Answer 12

Sexually transmitted
Need to be vaccinated early
Only girls are vaccinated so far

Question 13

subglottic stenosis:

Answer 13

needs to be diagnosed fast as children cannot breathe and will die

Question 14

adult subglottic stenosis:

Answer 14

due to vasculitis

Question 15

burns:

Answer 15

Must move ASAP
Can melt things inside
You need to secure airway fast
Neck will swell up

Question 16

what should be assessed in a patient with suspected ted airway obstruction?

Answer 16

appearance, work of breathing and skin circulation

you must not be able to hear your breathing unless your breathing goes up like in a cold or asthma

Question 17

respiratory distress in babies leads to?

Answer 17

respiratory failure ->respiratory arrest -> cardiac arrest

Question 18

what three things could cause death in a patient with airway obstruction?

Answer 18

neurological, cardiovascular and respiratory failure

Question 19

what is the management in someone with airway obstruction?

Answer 19

A,B,C: Resuscitation
Oxygen
Heliox
Steroid
Adrenaline
Flexible fibre-optic endoscopy
Secure airway with ET Tube/Tracheostomy
Treat underlying pathology

Question 20

how should airway endoscopy be carried out when dealing with airway obstruction?

Answer 20

Rigid Endoscopy and / or Flexible Endoscopy

Examination Without the ET tube is the best option

Question 21

what is used to give general anesthesia?

Answer 21

Anaesthetic Gas (Sevoflurane)

Intravenous Anaesthesia
Propofol, Remifentanyl

Question 22

what is used as pharmacotherapy?

Answer 22

Heliox (79% Helium+ 21% Oxygen
Nebulised Budesonide 2mg
Dexamethasone 0.15-0.6 mg/kg
Nebulised Adrenaline 1:10000 (5ml)

Question 23

what procedures can be carried out for dealing with airway obstruction?

Answer 23

Direct Laryngoscopy
Microlaryngoscopy
Examination with Hopkins Rods
LaryngoTracheoBronchoscopy

Question 24

tracheostomy?

Answer 24

Tracheostomy should be avoided at all possibilities