Upper Airway Obstruction

Question 1

What are the causes of upper airway obstruction?

Answer 1

1. Congenital - tracheal stenosis

2. Acquired - infection, trauma, malignant tumour, inflammation

Question 2

How is a suspected upper airway obstruction assessed?

Answer 2

1. Admit even if for a short period for observation
2. Cyanosis is a very late sign
3. Stridor? RR >20? Sats falling (late in children and elderly)?
4. Count from 1-10 without stopping/gasping for air?

Question 3

How can you tell if an upper airway obstruction is severe?

Answer 3

Sat up, intercostal recession, accessory muscles, tracheal tug, stridor, cyanosis.

Question 4

What is the medical management of upper airway obstruction?

Answer 4

1. Oxygen via nasal prongs
2. Nebulised adrenaline
3. Heliox, less dense than air, more oxygen gets to lungs.

Question 5

What is the surgical management for upper airway obstruction?

Answer 5

1. Endotracheal intubation (anaesthetist)
2. Cricothyroidotomy (absolute emergency, insert hollow tube into trachea through cricothyroid ligament)
3. Thyroidectomy (consult seniors but do not leave too late)