Upper Airway Obstruction Flashcards
Definition?
This is when the upper airway between the oral cavity and subglottic region, is either partially or entirely obstructed. This can be due to a foreign object, inflammatory secretions or masses.
Risk factors?
contents, central drive, compression, direct trauma, artificial airways, excess granulation tissue, neuromuscular disorders
aetiology congenital?
Stenosis or narrowing of the trachea
Laryngomalacia-floppy larynx
Congenital HPV-warts in upper aerodigestive tract
aetiology acquired?
o Infection – viral or bacterial eg epiglottitis, tonsillitis, glandular fever, infection of floor of mouth
o Angioneurotic oedema-swollen tongue
o Ludwig’s angina
o Inflammation – smoke inhalation
o Tumour
o Benign
o Malignant – primary or secondary cancers
o Trauma-swelling in airway could obstruct-key window is 8-12 hrs
o Blunt
o Penetrating
Clinical Presentation?
cyanosis stridor high resp rate hypoxic not talkative/crying stertor Increased work of breathing with obstruction to the upper airway Intercostal recession Tracheal tug
Investigations?
ABCDE and vital signs/resp exam
1st line of management?
medical, oxygen, nebulised adrenaline, steroids
2nd line of management?
endotracheal intubation-Intubating laryngoscope inserted into the vallecula, by lifting tongue up and forwards to see epiglottis and insert tube through vocal cords
If not needed, then ENT surgeon performs nasendoscope and monitored and given antibiotics and steroids.
3rd line of management?
tracheostomy-This is a surgical procedure which builds up a surgical airway in the cervical trachea, where a tube can be inserted in order to facilitate breathing. This tube can be connected to a ventilator if necessary or used to suck out secretions.
Process of tracheostomy?
Horizontal incision in the skin
Strap muscles separated in the midline
Thyroid isthmus divided and oversewn
window in the trachea below the level of the vocal cords
Outer tube, inner and introducer/trochea
Sizes-men(8), women (6/7), children (pinky circumference)
Post-tracheostomy management?
humidification, cleaning, suction
4th line of management?
Patient supine with neck extended
Palpate the most prominent part of the thyroid cartilage in the midline
Run you finger inferiorly for 1.5 cm and feel the cricothyroid membrane
If you are uncertain fill syringe with saline, insert needle and withdraw, an air bubble indicates you have entered the airway and leave cannula in-can attach iv tube for oxygen
Mini-trach or biro-incision made at cricothyroid membrane-turn 90degrees and insert empty biro/tube
Complications of tracheostomy and cricothyrotomy
· Damage to local structures · Haemorrhage · Surgical emphysema of pleura in children · Infection Stenosis of trachea
Complications of endotracheal intubation
· Damage to theteeth · Esophagealintubation · Unilateral bronchialintubation · Trachealperforation · Hemorrhage · Pulmonaryaspiration · Infections · Late complications afterintubation:vocal cordinjuries,vocal cord granuloma Complications oflong-termintubation-Tracheal stenosis,tracheomalacia
