Upper Airway

Question 1

what are the signs and symptoms of upper airway obstruction

Answer 1

noisy breathing/stridor
increased SOB
change in voice
local pain 
dysphagia 

breathlessness - increased RR, suprasternal retraction, accessory muscle use in respiration, restlessness
drooling
subcutaneous emphysema

Question 2

how do you treat an upper airway obstruction

Answer 2

clear airway
give O2
consider airway adjunct (mask, intubation, cricothyroid puncture, tracheostomy)

Question 3

what is heliox

Answer 3

oxygen and helium for easierr breathing in an 80:20 mix

Question 4

what is the difference between stridor and stertor

Answer 4

stertor = low pitch snoring sound indicating oro/nasopharyngeal obstruction

stridor = high pitch, sign of respiratory obstruction

Question 5

what causes stridor

Answer 5

vocal cord palsy
subglottic stenosis 
trauma
foreign body
epiglottitis
croup
laryngeal carcinoma
subglottic stenosis
laryngeal papillomata
laryngeal polyps
external compression

Question 6

how do you classify stridor

Answer 6

INCREASING IN SEVERITy 
only on exertion 
only of deep inspiration 
audible all the time able to hold a convo 
has to talk in short phrases
only able to get odd words out
unable to talk - accessory muscle use
cyanosed
respiratory arrest

Question 7

whats an important thing that needs replacing when a tracheostomy is inserted

Answer 7

humidifying/warming functions of nose and upper airway

Question 8

what are indications for a tracheostomy

Answer 8

obstruction
odema
secretions 
prevent overspill (preventing aspiration pneuomonia following neurological disease) 
post-laryngectomy 
ventilation (if on respiratory support)

Question 9

what are the 2 types of tracheostomy

Answer 9

end - performed as part of laryngectomy

side - larynx still in place

Question 10

what are early complications of a tracheostomy

Answer 10

tube displacement 
blocked tube from dry secretions 
pneumothorax
local infection 
dysphagia 
surgical emphysema

Question 11

what are late complications of tracheostomy

Answer 11

tracheocutaneous fistula on removing tube
tracheo-osophageal fistula
tracheal stenosis

Question 12

what tends to be the outcome fo a tracheostomy

Answer 12

most side ones are reversed eventually

tube is blocked for 24-48 hours to see if patient can breathe first

Question 13

what are the long term tracheostomy tubes built out of

Answer 13

silver

Question 14

what should you cut in an EMERGENCY tracheostomy insertion

Answer 14

inbetween thyroid cartilage and cricoid bone (between the two bumps on the neck) - the cricothyroid membrane

Question 15

where is a surgical tracheostomy placed

Answer 15

below the cricoid cartilage