Lecture 20- Conditions involving the larynx and airway management Flashcards
conditions affecting the larynx
- Laryngitis
- Laryngeal nodules
- Laryngeal cancer
- Laryngeal oedema
- Epiglottitis
Laryngitis
inflammation of larynx, often involving true vocal cords
- Diagnosed clinically from history
- Hoarse/weak voice and sore throat
- History of URTI
- Infectious (viral typically) and non-infectious aetiology
- Persistent strain on the voice (non-infectious)
- Usually self limiting- resolves within 2-3 weeks
- Laryngeal nodules
- Acute trauma or chronic irritation
- ‘singers nodules’
- Hoarseness of voice >3 weeks
- Require visualisation of cords +/- biopsy
- Laryngeal cancer
certain conditions causing swelling of the larynx can present as
immediate threat to the airway
patient with a compromised upper airway will present with
stridor, raised resp rate distress, hypoxia +/- cyanosis
Stridor-
noise of upper airway pathology
noise of lower airway pathology
wheezing
- Laryngeal oedema
e.g. allergic reaction or swallowed foreign body (choking)
- Epiglottitis- rare
- Potentially significantly airway threatening
- Inflammation in epiglottis- obstructs breathing and swallowing
- Symptoms and signs
- Saliva drooling
- High fever, sniffing position (head slightly extended at the neck)
- DO NOT EXAMINe THE THROAT OR LARYNX–> distress can cause deterioration
- Causes: Haemophilus influenzae
croup
- Common, usually not severe
- Symptoms
- Barking cough
- Symptoms worsen with agitation- stridor
- Cause
- Viral
- Treatment
- Doesn’t require hospital admin usually
- If stridor present at rest may need emergency intervention
hypokia
kills
airways are actively held open by
- Actions and general tone in muscles of upper pharynx/larynx/tongue
- Protective reflexes
- Gag
- Cough
- Swallow
- Complex neural pathways and reflexes involving: co-ording and maintain these to keep the airway patent and safe
- Intact when conscious (providing no lesions/pathology effecting nerves)
- Decreased conscious levels cause decreased tone and suppression of reflexes
AIRWAY AT RISK
Relaxation of tone and suppression reflexes- occludes the larynx
airway management can be
planned or emergency
Airway management
- Planned (elective)
E.g. in prep for surgery involving general anaesthetic
airway manegement: Emergency
Acute/immediate threat to airway- conscious e.g. laryngeal oedema and unconscious patient e.g. cardiac arrest
E.g. Ludwigs angina
E.g. Ludwigs angina
Ludwig’s angina (lat.: Angina ludovici) is a type of severe cellulitis involving the floor of the mouth. Early on the floor of the mouth is raised and there is difficulty swallowing saliva, which may run from the person’s mouth.
Simple airway manoeuvres
- To open the airway
- Head tilt
- Chin lift
aireay adjuncts e.g.
helpful in supporting simple manoeuvres and maintain patent upper airway
oropharyngeal and nasopharyngeal airway
- Oropharyngeal airway (Guedel)
- Contraindicated if minimal depression of consciousness (can illicit gag reflex)
- Goes through oral cavity
- Sits in oropharynx
- Nasopharyngeal airway
- Goes through nasal cavity
- Sits in oropharynx
airway adjunctions positives and negatives
allows for sponetaenous ventilaiton (if the patient is able to breath spontaneously)
HOWEVER
offers no protection of the lower resp tract e.g. from vomit or secretions
Devices used to better secure airway
supraglottic airway i.e. iGel
definitive airway: intubation
supraglottic airway i.e. iGel
- Minimal technical skills required to insert
- Often first line in cardiac arrest
- Not for long term ventilation e.g. if in ITU
- Definitive airway: Intubation
- Endotracheal tube
- Technical skills required
- Requires use of laryngoscope to visualise vocal cords
- Secures and protects e.g. from secretions and vomit from the lower resp tract
- Patient (if not in cardiac arrest) anaesthetized prior to insertion
what is this
nasopharyngeal airway
what is this
endotracheal tube
what is this
oropharyngeal airway (OPA)
what is this
Supraglottic airway i.e. iGel
to put in an endotracheal tube (definitive aireay) you must use
laryngoscope
case 1- what are the key features of this illness
- Antivaxxer parents
- Harsh respiratory noise- stridor
- Sore throat
- Lethargic
- Sitting in still ‘sniffing’ position
- Dribbling
- Breathing rapidly
- 39.5- pyrexia
- Think infection
- What is epiglottitis
- Inflammation of the epiglottitis and supraglottis regions
- Narrowing of laryngeal inlet through inflammation of the epiglottitis
- Usually rare due to Hib vaccination
- What would be your differential diagnosis in a patient presenting with similar signs and symptoms (epiglottitis)?
- Croup
- Foreign body in airways
- Laryngeal oedema
- Retropharyngeal abscess
- Common cause of epiglottitis
Haemophilus influenza type B
- Pseudomonas aeruginosa related to which H+N infections
- Why do you think the girl sitting with her head held in a sniffing position and what does the hard inspiratory noise suggest?
- Head tilt chin lift
- Holds the airway more patent
- Maintain airway
- Stridor= airway obstruction in the upper respiratory tract
movement of which cartilage moeves the vocal cords
arytenoid cartilage
label
A- epiglottis
B- aryepiglottic folds
C- false vocal cords- vestibular fold
D- true vocal cords- vocal folds
what is the region shaded in yellow
supraglottic
why must you not attempt further exam or take bloods from girlw ith potential epiglottitis
Distress can decrease the patency of the airway – exacerbate inflammation
- Deterioration causing complete airway obstruction
name the order of structures the endotracheal defintive airway) will have passed throguh to reach the trachea
- oral cavity
- posterior third of the tongue
- epiglottis and aryepiglottic fold
- supraglottis (laryngeal vestibule)
- false vocal cords
- true vocal cords
- infraglottis
- trachea
name these airways in order
1 Oropharyngeal airway
2 Nasopharngeal airway
3 Laryngeal mask- supraglottic airway
4 Endotracheal tube
case study 2- key features
-
Key features
- Thyroid operation
- Hoarseness of voice
- Cough
- Gag reflex is weak
- Left vocal fold in a paramedian position (should be more abducted)
- Case study 2- Describe why these symptoms have developed?
- Left recurrent laryngeal nerve palsy (branch of vagus nerve)
- Which supplies the left side of the larynx
- Caused by damage in thyroid surgery- local structures (runs in the tracheooesophageal groove)
case study 2 Explain why the women’s cough was weak?
- lack of forcible adduction of the vocal chords (unable to fully raise intrathoracic pressure)
- Due to weakness in left vocal chord (need to adduct together)
case study 2- What symptoms might pt develop if the external branch of the superior laryngeal nerve were injured?
- External branch of superior laryngeal nerve innervates the cricothyroid muscle
- When it contracts it tilts the thyroid cartilage forward and downwards, increasing tension in the vocal chords- achieve higher pitch
- Struggle to produce higher pitched sounds
