Airway obstruction - upper

Question 1

Acute upper airway obstruction - definition

Answer 1

Dynamic or fixed extrathoracic airway obstruction (trachea and up)

Question 2

Acute upper airway obstruction - signs of partial acute UAO (3)

Answer 2

1. Stridor

Increased work of breathing

2. Suprasternal, intercostal and subcostal retraction
3. Increased use of accessory muscles of respiration

Question 3

Acute upper airway obstruction - signs of deterioration and indications for urgent intervention (3)

Answer 3

1. Hypoxia - worried/unsettled appearance, restlessness
2. Fatigue or decreasing conscious state
3. Increasing work of breathing

Question 4

Acute upper airway obstruction - ddx

Answer 4

1. Croup
2. Epiglottitis, bacterial tracheitis
3. Inhaled foreign body
4. Anaphylaxis
5. Retropharyngeal or peritonsillar abscess

+ pre-existing stridor (infant) = congenital abnormality, e.g. laryngomalacia, haemangioma/subglottic stenosis

Note: high degree of overlap between epiglottitis, bacterial tracheitis and upper airway abscess

Question 5

Acute upper airway obstruction - mx

Answer 5

1. Allow child to settle quietly on parent’s lap in the position that the child feels most comfortable. Observe closely with minimal interference
2. Treat specific cause
3. Call PICU if worsening or severe obstruction
4. Oxygen can be given while awaiting definitive tx; this can be falsely reassuring bc a child with quite severe obstruction may look pink in oxygen
5. Defer IV access - upsetting the child can cause increasing obstruction