Airway obstruction Flashcards
special airway features of neonates and babies:
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)
what is the equation for the relationship between airflow resistance and radius?
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
what are the causes of airway obstruction?
Inflammatory/Infective causes /Allergy Foreign bodies Physical compression/invasion of airway Trauma/Iatrogenic Trauma Neurological causes Neoplastic causes Burn Congenital airway pathology
what are the signs and symptoms seen in airway obstruction?
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
what is stridor?
High pitched harsh noise due to turbulent airflow resulting from airway obstructions
worrying symptom
what is stertor?
Low pitched sonorous sound arising from nasopharyngeal airway, lots of bass into the sound, usually with adenoids are swollen. No reason to be worried
what is seen in children with sleep apnea?
huge tonsils and adenoids
what color is the airway in acute epiglottis?
cherry red
acute epiglottis:
decrease in infection these days
foreign bodies as a cause of airway obstruction:
Organic stuff are extremely inflammatory and can close of one side of the bronchus and give pneumonia
is malignant pathology a cause of airway obstruction?
yes
recurrent respiratory papillomatosis:
Sexually transmitted
Need to be vaccinated early
Only girls are vaccinated so far
subglottic stenosis:
needs to be diagnosed fast as children cannot breathe and will die
adult subglottic stenosis:
due to vasculitis
burns:
Must move ASAP
Can melt things inside
You need to secure airway fast
Neck will swell up
what should be assessed in a patient with suspected ted airway obstruction?
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
respiratory distress in babies leads to?
respiratory failure ->respiratory arrest -> cardiac arrest
what three things could cause death in a patient with airway obstruction?
neurological, cardiovascular and respiratory failure
what is the management in someone with airway obstruction?
A,B,C: Resuscitation Oxygen Heliox Steroid Adrenaline Flexible fibre-optic endoscopy Secure airway with ET Tube/Tracheostomy Treat underlying pathology
how should airway endoscopy be carried out when dealing with airway obstruction?
Rigid Endoscopy and / or Flexible Endoscopy
Examination Without the ET tube is the best option
what is used to give general anesthesia?
Anaesthetic Gas (Sevoflurane)
Intravenous Anaesthesia
Propofol, Remifentanyl
what is used as pharmacotherapy?
Heliox (79% Helium+ 21% Oxygen
Nebulised Budesonide 2mg
Dexamethasone 0.15-0.6 mg/kg
Nebulised Adrenaline 1:10000 (5ml)
what procedures can be carried out for dealing with airway obstruction?
Direct Laryngoscopy
Microlaryngoscopy
Examination with Hopkins Rods
LaryngoTracheoBronchoscopy
tracheostomy?
Tracheostomy should be avoided at all possibilities
