Upper airway Flashcards
What are the signs/symptoms of upper airway obstruction?
stertor or stridor
What is stridor?
High pitched noisy breathing due to respiratory obstruction
What is stridor commonly caused by?
A respiratory obstruction such as:
croup
allergic reaction (anaphylaxis)
a foreign body
abscess
cancer
What is stertor?
Low pitched noise
on inspiration (ABOVE the larynx)
What is a common cause of stertor?
Enlarged tonsils
What is a tracheostomy?
A hole is made in the trachea and a breathing tube is inserted.
What are the functions regarding breathing of the nose?
Humidifying, filtering and warming the air
What are the indications for a tracheostomy?
Obstructive reason
-> Bypass an obstruction above the tracheostomy
Surgical reasons:
- > To prevent breathing problems from swelling of the larynx post surgery - > Post-laryngectomy
Lowered consious level reasons:
- > Aritificial respiration - > If there is substantial risk of aspiration
What are the two types of tracheostomy and what are their indications?
a) end tracheostomy – performed as part of a laryngectomy
b) side tracheostomy – here the larynx is left in place and an airway is put through the skin over the trachea. For shorter term reasons.
What are some early risks of tracheostomy?
Pneumothorax
Dysphagia
Surgical emphysema
tracheitis
What are some late risks of tracheostomy?
tracheocutaneous fistula on removing the tube
tracheaoesophageal fistula
tracheal stenosis
What causes snoring?
Vibration of one or more areas of the upper airway.
What is obstructive sleep apnoea hypopnoea syndrome (OSAHS)?
excessive daytime sleepiness
with repeated collapses of the upper airway
usually associated with desaturations
Describe what happens when a pt stops breathing due to sleep apnoea?
hypoxia occurs
a central impulse then causes a slight lightening of consciousness
and an increased respiratory effort
to overcome the obstruction.
What is the relationship between sleep apnoea and snoring?
Not all people who snore have sleep apnoea
but
all people who have sleep apnoea will snore
What is the diagnostic criteria for sleep apnoea?
30 or more episodes of cessation of breathing
each lasting at least 10 seconds
occurring over a 7 hour period of sleep.
How can one differentiate between sleep apnoea and snoring?
Snoring is disruptive snoring without any impact on:
sleep pattern or
daytime sleepiness
Are men or women more likely to develop snoring/sleep apnoea? (Why?)
Men are 2-5 times more likely.
Oestrogen is thought to be protective as risk increases post menopause
Which age groups are most at risk from snoring/sleep apnoea?
The risk constantly increases until 60 y/o
What is the link between obesity and snoring/sleep apnoea?
70% risk if BMI >40
What social habits can increase the risk of snoring/sleep apnoea?
Smoking + drinking
What are the consequences of sleep apnoea?
a) Neurocognitive effect – daytime sleepiness causes
a cognitive deterioration
and can increase the risk of an accident (e.g. RTA)
b) Cardiovascular – can contribute to
systemic hypertension
as well as pulmonary hypertension
and eventually ventricular failure (i.e. cor pulmonale)
How can snoring/sleep apnoea be assessed?
Sleep studies
Invasive endoscopies with vibration detector on them
When are sleep studies indicated in snoring/sleep apnoea?
Pt’s with COPD or resp problems
For truckers/heavy machinary workers
Pt’s being considered for surgery
What is the demographic of snoring/sleep apnoea in children?
is similar in both sexes and does not increase with age
What is the peak age for snoring/sleep apnoea in children? (and why)
Between 2 and 5 y/o
it is when the adenoid and tonsils are largest
What are the signs of snoring/sleep apnoea in children?
It’s paradoxical:
Failure to thrive (rather than obesity)
Overactive (rather than sedated)
What are the generic treatments for sleep apnoea?
1) Weight loss (very effective)
2) Lifestyle changes - alcohol, smoking, sedatives
3) Continuous positive airway pressure (CPAP)
4) Intra-oral appliances
5) Pharmacological treatments
6) Upper airway surgery (e.g. tracheostomy) /radioablation
What is the gold standard treatment for snoring/sleep apnoea and describe how it works?
Continuous positive airway pressure (CPAP)
Pt wears a mask that delivers a +ve pressure
thus keeping the airway open after expiration preventing obstruction
(pts do not like it)
What are intra-oral appliances and what are the side-effects?
devices that open the airway or
fix the mandible in place
side effects such as
drooling
joint discomfort
When do episodes of snoring/sleep apnoea occur most in the sleep cycle?
REM sleep
What are the mechanisms used to treat snoring/sleep apnoea with pharmacological agents?
either:
reduce the amount of REM sleep or
to increase respiratory effort.
(both can be effective in selected patients)
What are the two types of stridor and what levels do they occur at?
inspiratory (level of larynx)
and/or
expiratory (level of bronchi/bronchioles), it is the wheeze of asthma
What is the umbrella term that encompasses snoring and sleep apnoea?
Obstructive sleep related breathing disorders (SRBDs)
What is upper airways resistance syndrome (UARS)?
Essentially snoring with increased respiratory effort
What is apnoea?
stopping of breathing
What are the risks of acute epiglottitis?
It is potentially life threatening due to airway obstruction
What is croup also called?
Laryngotracheobronchitis
What is croup characterised by?
Oedema and vascular engorgement of the airways
What are the signs of croup?
intially a low-grade URTI
then inspiratory stridor
then cough like bark of dog
Who can be affected by acute epiglottitis?
adults and children
What is the most common causative aetiological agent in acute epiglottitis?
Haemophilus influenzae type b (Hib) but less common due to vaccination
What is the tell-tale sign that a child has acute epiglottitis?
They drool as its too painful to swallow
What must you be careful not to do in children with suspected airway obstruction?
Do not make them cry by upsetting them as this may further compromise the airway.
What age group does epiglottitis commonly occur in in children?
3-6 yrs
What age group does croup commonly occur in in children?
1-8yrs
How fast is the onset of acute laryngitis?
gradual
How fast is the onset of acute epiglottitis?
rapid
How fast is the onset of croup?
gradual (after cold)
What is the treatment for acute larngititis?
supportive
What is the treatment for acute epiglottitis?
antibiotics
intubation
What is the treatment for croup?
nebulised racemic of adrenaline and bronchdilator
systemic steroids
In airway obstruction what can help buy time before an expert arrives?
Heliox (mixture of Helium and Oxygen)
What is treatment of choice for OSAS in children?
adenotonsillectomy
Other than obstructive sleep apnoea syndrome (OSAS), what is the other type of sleep apnoea?
Central sleep apnoea (essentially a loss of central respiratory drive)
