Upper Airway Flashcards
What are the signs and symptoms of upper airway obstruction?
Symptoms:
Breathlessness
Signs:
- Stridor (wheeze suggest lower airway obstruction) it is usually inspiratory, if it is also expiratory suggests worse prognosis.
- Drooling as airway becomes more obstructed patient will have difficulty swallowing
- Patient ‘tripoding’ prefering to be seated leanig forward with there elbows on there knees, this position helps open up the upper airways and is the best position for the accessory respiratory muscles.
- Central cyanosis
- Reduced consciousness or confusion
What is the difference between stretor and stridor?
Stretor is airway obstruction above the level of the larynx. It produces a low pitched snoring like sound on inspiration.
Stridor is airway obstruction below the larynx but in the upper airway and produces a high pitched gasping sound on inspiration.
Know the principles of managing acute upper airway obstruction?
Call for help.
Clear airway of dentures, or obvious foreign bodies or vommit using a gloved finger or suction.
Give patient heliox if cyanosed but still breathing (mix of helium and oxygen) easier to breath.
Attempt to secure airway using LMA.
If not possible and not breathing: cricothyroidotomy to create temporary airway.
Intubation or tracheostomy if not possible to intubate.
What are the causes of upper airway obstruction? (5 adults) (6 children)
Adults:
Anaphylaxis
Foreign Body
Airway Trauma
Infection (Laryngitis, Epiglotitis, Retropharyngeal abscess, Diphtheria. Tuberculosis. Syphilis. Sarcoidosis. Wegener’s granulomatosis.)
Laryngospasms (hypocalacaemia)
Tumours, local or those in surrounding structures compressing from the outside.
Children:
Croup (laryngotracheobronchitis)
Anaphylaxis
Foreign body
Epiglottitis
Abscess (retropharyngeal or peritonsilar)
Congenital problems: (laryngomalacia, vocal cord dysfunction etc)
What is laryngotracheobronchitis, how does it present and how is it managed?
It is a viral infection of the larynx that is relatively common in childhood and is the leading cause of upper airway obstruction in children.
It usually presents gradually after a cold.
Patient will have stridor and a harsh voice.
Temp usually
What is epiglottitis, how does it present and how is it managed?
Epiglottitis is inflammation of the epiglottitis and it is usually caused by infection with HIB. It is a life threatening infection in both children and adults. (More common in children)
It presents with:
A severe sore throat. (Out of proportion to the appearance of the throat.)
Temp >39
Stridor.
Drooling as they are having difficulty swallowing there saliva.
Rapid onset and most commonly occurs in children between the ages of 3-6.
Treatment is with:
Heliox (for children)
Intubation
IV antibiotics
Note: HIB epiglottitis is a notifiable disease.
If you suspect epiglottitis in children avoided agitating them as this will worsen there condition and ensure all procedures are carried out in an environment where an experienced ENT consultant or anaethetist is available to secure the airway.
How do you manage anaphylaxis?
ABCDE.
Stop any offending allergen if still exposed.
High flow oxygen.
IM 0.5 mL of 1:1000 adrenaline (adults)
(0.3ml 6-12yo) (0.15ml
What questions should you ask yourself when assessing the severity of stridor?
- Only present on exertion
- Only present on deep inspiration
- Audible all the time but able to hold a normal conversation
- Has to talk in short phrases
- Only able to get odd words out as concentrating on breathing
- Unable to talk, using accessory muscles of respiration (intercostal recession or tracheal tug)
- Cyanosed
- Respiratory arrest
What is a tracheostomy and what are the indications?
An operation whereby a small hole is made through the skin over the lower part of the neck into the trachea and a special breathing tube (‘tracheostomy tube’) is inserted into the hole to keep it open.
Indications:
Severe obstruction of the upper airway caused by:
Infection, anaphylaxis, neoplasms, or foreign bodies.
To prevent breathing problems following major neck surgery.
In patients needing long term artificial ventilation as it is difficult to remove secretions via an endotrachial tube and therefore this can leave patients prone to infection , also as long term the pressure from the endotracheal tube can damage the lining of the larynx leading to scarring.
What are the complications of tracheostomy?
Complications: Tube displacement Blocked tube from dried secretions or blood clots Surgical emphysema Pneumothorax (more common in babies) Tracheal-oesophgeal fistula Tracheal-cutaneous fistula Tracheal stenosis
Aim is to remove the tracheostomy as soon as possible.
What is the difference between and end tracheostomy and a side tracheostomy?
End tracheostomy is performed as part of a laryngectomy where all of the larynx is removed and disconnected from the trachea. Patients will have to relearn speech.
Side tracheotomy: Here the larynx is still in place and a small hole is created between the skin over the lower neck and the trachea.
What is the difference between snoring and sleep apnoea?
Simple snoring: is due to airway resistance however in snoring it does not have an impact on the patients sleep.
Obstructive sleep apnoea: is categorised by the co-existence of excess daytime sleepiness with interrupted and repeated collapse of the upper airway during sleep, usually with associated de-saturations.
What factors contribute to sleep apnoea? What are the symptoms and complications?
Obesity Age (risk increases with age) Gender (more common in men) Lifestyle factors (smoking and alcohol) Congenital abnormalaties
Major complaint is severe day time tiredness.
Also has a strong link to hypertension
How can you manage sleep apnoea?
Lifestyle changes:
Lose weight.
Reduce/quit smoking and alcohol
Sleep on side
Medical management involves the use of a CPAP machine (Continous positive airway pressure)
