Airway Obstruction

Question 1

What are some features of the airways of children that are different from adults?

Answer 1

Large head, small nares, neonates are obligate nasal breathers, relatively large tongue, small/soft larynx, higher position (C1), weak neck muscles (floppy head), narrow subglottis (3.5mm at cricoid)

Question 2

What are some physiological principles relevant to airways?

Answer 2

Poiseuille’s equation and Bernoulli principle/Venturi effect

Question 3

What are some causes of airway obstruction?

Answer 3

Inflammatory, infective, allergy, foreign bodies, physical compression/invasion, trauma, neurological or neoplastic causes, burn, congenital airway pathology

Question 4

What are the symptoms of airway obstruction?

Answer 4

SOB on exertion/at rest, stridor, stertor, coughing, choking, inability to complete sentences, sternal/subcostal recession, tracheal tug, dysphagia, dusky skin colour

Question 5

What is stridor?

Answer 5

High pitched harsh noise due to turbulent airflow resulting from airway obstruction

Question 6

What is stertor?

Answer 6

Low pitched sonorous sound arising form nasopharyngeal airway

Question 7

What are some pathologies that may cause airway obstruction?

Answer 7

Acute epiglottitis, foreign bodies, recurrent respiratory papillomatosis, subglottic stenosis

Question 8

What are some management options for airway obstruction?

Answer 8

ABC approach = resuscitation

Oxygen, heliox, steroids, adrenaline, flexible fibre-optic endoscopy, secure airway with ET tube, treat underlying cause

Question 9

What are the two kinds of endoscopy?

Answer 9

Rigid and flexible

Question 10

Should an examination of the airway be carried out without the ET tube?

Answer 10

Yes = is best option to do it without

Question 11

What are the types of general anaesthetics used when doing an airway endoscopy?

Answer 11

Gas = sevoflurane
IV = Propofol, remifentanyl

Question 12

What pharmacotherapy is given during an airway endoscopy?

Answer 12

Heliox = 79% helium and 21% oxygen
2mg nebulised budesonide
0.15-0.6 mg/kg dexamethasone
1:10000 nebulised adrenaline

Question 13

What are the types of airway endoscopy that may be done for an obstruction?

Answer 13

Direct laryngoscopy, microlaryngoscopy, examination with Hopkins rods, laryngotracheobronchoscopy

Question 14

What should only be considered as a last line treatment option in patients with an airway obstruction?

Answer 14

Tracheostomy