Airway Emergencies

Question 1

what are the causes of airway obstruction?

Answer 1

foreign body, tumour, infection (epiglottitis/supraglottis)

Question 2

what is the acute management of airway obstruction?

Answer 2

o Give O2 or Heliox

o Nebulised adrenaline or steroids

Question 3

how is an airway secured in airway obstruction?

Answer 3

Intubation – nasopharyngeal, oropharyngeal airway
Tracheostomy
Cricothyroidotomy

Question 4

Ear and Nose foreign bodies obstruction are common in…

Answer 4

children, people with learning difficulties and patients with psychiatric conditions

Question 5

oesophageal soft foreign bodies obstruction are common in…

Answer 5

older people or with oesophageal disorders

Question 6

what are the important parts of the history to ask in ear foreign bodies?

Answer 6

pain or discharge from the ear, and any associated hearing loss*

Question 7

what are the important parts of the history to ask in nose foreign bodies?

Answer 7

issues with breathing and about any nasal discharge

Question 8

what are the important parts of the history to ask in ingested foreign bodies?

Answer 8

clarify specifically the nature of the object, whether sharp (e.g. a fish bone) or soft (e.g. cooked meat); check for any dysphagia, including if the patient is able to swallow saliva

Question 9

what investigations are done for ENT foreign bodies?

Answer 9

o Ear = Otoscopy
o Pharynx - Lack’s tongue depressor and head-torch. , flexible nasal endoscopy (FNE)
o Sometimes Xrays

Question 10

what foreign body is most urgent to remove in ENT?

Answer 10

Button batteries can erode and cause irreversible caustic burns, therefore any button battery ingested must be removed immediately.

Question 11

how are ear foreign bodies removed?

Answer 11

via microsuction with a Zoelner sucker, crocodile forceps, Jobson-Horne probes, or wax hooks

Question 12

how are nose foreign bodies removed?

Answer 12

removal under GA should be performed if the patient is distressed or any signs of breathing difficulty, or unable to remove.

Question 13

how are foreign bodies removed from the throat?

Answer 13

If visualised removal via Magill forceps

Otherwise endoscopy under GA

Question 14

Urgency factors of foreign body removal?

Answer 14

 Emergency endoscopy
 Any red flag signs
 Any sharp or long (>5cm) object in the oesophagus
 Urgent endoscopy (within 24 hours)
 Oesophageal obstruction (unable to swallow saliva)
 Blunt oesophageal FB
 Magnets proximal to the duodenum
 Non-urgent endoscopy
 Disc or cylindrical batteries which have passed into stomach without signs of injury
 Coins may be observed for up to 24 hours before removal if asymptomatic