Upper Airway Flashcards
stridor
- what is stridor
- what is stertor / snoring
- stridor is the high pitched breathing sound caused by turbulent airflow in larynx or lower in the bronchial tree. caused airway obstruction
- stertor / snoring is the noise produced by the pharynx - commonly base of tongue against soft palate
- image shows respiratory tract anatomy*
upper airway obstruction - causes
-congenital (4)
-acquired
>acute (5)
>chronic (5)
-congenital
>laryngomalacia (an exessively ‘floppy’ airway with a tendency to collapse on inspiration), vocal cord web, vocal cord palsy, subglottic stenosis
-acquired
>acute - trauma (eg fractured larynx), foreign body, angioedema (ie allergic reaction), epiglottitis (inflammed epiglottis. commonly caused by bacterial infection) croup ( inflamed larynx, trachea and bronchi, commly caused by viral infection), vocal cord palsy
>chronic - vocal cord palsy, carcinoma, subglottic stenosis (eg after prolonger intubation), , vocal cord polyp or cyst, papillomata (benign growth), external compression (eg thyroid mass)
image shows upper airway anatomy
upper airway obstruction - signs and sx
- o/e (9). obs (2)
-complete upper airway obstruction
>o/e cough, stridor, wheeze, drooling, silent (if total obstruction), may hold throat between thumb and index finger (universal choking sign), anxious/agitated, vigorous attampts at respiration - intercostal and supraclavicular retraction, cyanosis
>increased rr and hr
>if complete obstruction not relieved - loss consciousness, decrease hr, rr, bp, cardiac arrest
upper airway obstruction
-first consider
- > first aid if forgein body (encourage coughing, back slap, heimlick), >call for help (admission to hospital or call senior or rescuss team), >does pt just need observation*
- >does pt need intervention (is pt deteriorating/unstable)*
- >interventions - o2, nebulized adrenaline, procedures*
- emergency mx
> procedures (3)
- endotracheal intubation - (EXPERT EMERGENCY) need laryngoscope and ET tube (on rescuss trolley), need skilled staff (anaesthestist, emergency doctor), need access.
- cricothyroidotomy (EMERGENCY) - need a wide bore cannular
- tracheostomy - usually elective, sometimes done in emergency
emergency mx - endotracheal intubation
see image. et tube is inserted with aid of laryngoscope anaesthestics and emergency doctors trained to do this
cricothyroidotomy
- hollow tube (most commonly wide bore cannular) introduced into larynx via percutaneous route. inserted into neck in midline through cricothyroid membrane
- image shows anatomy*
image shows steps of procedure
tracheostomy
- what is tracheostomy (1)
- usually an elective producure. indicated who (2)
- emergency tracheostomy . what is done (4)
-tracheostomy = hole is made in front wall of trachera and tube maintains this airway
-indicated in pts who require long term assisted ventilation. or as part of a head and neck or airway operation
-emergency tracheostomy anaesthetists
>one hand supports laynx in midline and provides pressure on thyroid isthmus as it is divided to minimise bleeding
>other hand makes longitudunal incision with scalpel blade into trachea and twists sideways to keep trachea open
>tube inserted and secured
>then haemorrhage dealth with
-tracheostomy - images show steps for elective tracheostomy
care of a tracheostomy
- -when upper resp tract bypassed humidification functions of nose are lost*
- -trachea becomes dry and tends to crust blocking the tube*
- all pts must have a humidification of the air they breathe. regular suctions of lower airways in post op pts helps crusting.*
- -in time lining of trachea cyhanges to more robust squamous variety. need for humidification reduces*
- -pts must be shown how to clean and care for tube son discharge*
images show steps for elective tracheostomy
