Upper airway obstruction: diagnosis and emergency treatment

2021-08-03 12:24 AM

Acute upper airway obstruction may result from aspiration of foreign bodies, viral or bacterial infections, severe allergies, burns, or trauma

Acute upper airway obstruction, if detected and treated slowly, can have serious and sometimes life-threatening consequences.

Acute upper airway obstruction is an obstruction of the upper airways including the trachea, larynx, or pharynx.

Diagnosis of upper airway obstruction

Based mainly on clinical symptoms according to the degree of obstruction from mild to severe.

Shortness of breath.

Stridor: Isolated inspiratory stridor usually indicates obstruction above or at the epiglottis while expiratory stridor is characteristic of subchondral obstruction. Inspiratory laryngeal stridor is often mistaken for bronchial expiratory stridor.

Rapid shallow breathing or slow breathing. Severe cases may show signs of suffocation, yawning.

Sweating.

Contraction of accessory respiratory muscles.

The state of excitement, panic. In severe cases, consciousness disorder, confusion, loss of consciousness.

Cyanosis of the extremities (late sign).

On physical examination, laryngotracheal stridor (partial obstruction) may be heard with auscultation with bilateral decreased alveolar murmurs.

Diagnosis of upper airway obstruction

Partial obstruction: the patient has difficulty breathing, breathing with a hissing sound, agitation, sweating, voice changes, cough, difficulty swallowing...

Complete obstruction: the patient rapidly loses consciousness within seconds to minutes.

Note: Partial obstruction can rapidly progress to complete obstruction.

Diagnose the cause

Endogenous causes

Due to the collapse of soft tissues in the oropharynx (decreased muscle tone, jaw fracture).

Laryngeal edema/laryngospasm.

Acute epiglottitis, acute laryngitis, laryngeal diphtheria.

Bilateral vocal cord paralysis.

Allergies cause swelling of the lining of the throat and trachea, usually due to an allergic reaction to bee stings, antibiotics, or antihypertensive drugs (ACE inhibitors).

Laryngeal trauma, laryngeal tumor.

Exogenous causes

Ludwig-type angioedema/Focus of pus in the oropharynx.

Hematoma (due to coagulopathy, trauma, surgery).

Thyroid tumor.

Lymphoma.

Tumor or esophageal foreign body.

Foreign object

Food.

Toys with children or anything with dementia or mental patients.

Investigations to help diagnose the cause

Laryngoscopy.

Bronchoscopy.

Chest X-ray.

Emergency treatment of upper airway obstruction

Depends on the level of congestion.

In case of partial obstruction (air can still go in and out of the lungs)

Explain to patient peace of mind.

The Heimlich maneuver if an airway foreign body is present.

Oxygen has good humidification.

Monitor vital signs.

Have an intubation kit and sputum aspirator ready.

Nebulize adrenaline 1:1000 dilution. Dosage is 1ml for adults and 0.5ml for children.

Antibiotics: when there are signs of infection.

If the obstruction is complete and the patient shows signs of hypoxia (cyanosis, yawn breathing, impaired consciousness) proceed with airway management.

Open the airway: a head-up position to raise the chin.

Examine and remove foreign bodies with a laryngoscope and Magill forceps.

Remove sputum, blood, and pus in the mouth.

Emergency intubation

Oral intubation with light.

If difficult: endotracheal intubation upstream with a wire passing through the cricothyroid membrane.

Emergency tracheostomy across the cricothyroid membrane if intubation is not possible.

Prevention

Avoid factors that cause upper airway obstruction in at-risk subjects such as children, people with dementia, and psychiatric patients.

Early detection and prompt treatment of the causes of upper airway obstruction.