L24: Conditions affecting the airway and airway management

Question 1

What is laryngitis?

Answer 1

Inflammation of the larynx, often involving true vocal cords

• hoarse/weak voice and sore throat
• history of URTI
• infectious (viral typically) and non-infectious causes
• self-limiting, resolves within 2-3 weeks

Question 2

What are laryngeal nodules?

Answer 2

Arise due to acute trauma/chronic irritation (benign growths on the vocal cords)

• hoarseness of voice (>3 weeks)
• requires visualisation of the cords

(you can have laryngeal cancer)

Question 3

What are some conditions affecting the larynx that present with immediate threat to the airway?

Answer 3

Present with: stridor, raised resp rate, distress, hypoxia, +/- cyanosis

• laryngeal oedema (allergic reaction/choking)
• epiglottitis: rare, inflammation usually secondary to infection causing swelling of epiglottis and supraglottic tissues of the larynx- obstruction (sat in ‘sniffing’ position: opens up airway)
• croup: barking cough, caused by virus in children up to 3 years usually, settles within 48 hours usually, managed at home

Question 4

What do you not do when a child has epiglottitis?

Answer 4

Don’t examine the throat/place anything inside their mouth

-cause distress and rapid deterioration

Question 5

How is the airway physiologically managed?

Answer 5

• airway actively held open via actions and general tone in muscle of upper pharynx/larynx/tongue
• airway has protective reflexes: gag/cough/swallow

Question 6

When is the airway at risk?

Answer 6

Decreased levels of consciousness cause decreased tone and suppression of reflexes

Question 7

What are the different times you would manage an airway?

Answer 7

Planned: preparation for surgery involving general anesthetic
Emergency: acute/immediate threat to airway

Question 8

How do you provide a secure airway?

Answer 8

Intubate (put a tube through the oral cavity and down through the larynx into the trachea)

Question 9

What are some simple airway maneuvers?

Answer 9

-head tilt
-chin lift
As tongue can fall back and block the oropharynx

Question 10

What are airway adjuncts?

Answer 10

Helpful in supporting simple manouvers and maintain patent upper airway
-oropharyngeal airway (Guedel): tolerated better in unconcious patient, as you ellicit their gag reflex otherwise
-nasopharyngeal airway
No protection against secretions/vomit

Question 11

What is a supraglottic airway?

Answer 11

e. g. iGel
- maintains airway and affords soem protection
- minimal skill required to insert and iGel
- first line in cardiac arrest
- end of it hugs around the laryngeal inlet
- not long-term ventilation e.g. ITU

Question 12

What is a definitive airway?

Answer 12

Intubation

• requires laryngoscope to see where you are placing it
• endotracheal tube (through vocal cords, has a cuff which can be inflated in the trachea)
• protects against secretions or vomit
• patient anaesthetized prior to insertion
• requires technical skill

Question 13

How does a laringoscope work?

Answer 13

Lift the tissues anteriorly by pulling forward with the laringoscope which sits in the vallecula
-allows for good visualisation