Airway

Question 1

List 8 causes of airway obstruction

Answer 1

1. Unconscious patient - site of obstruction is more often at the soft palate and epiglottis (not the tongue)
2. Vomit (regurgitation of gastric contents)
3. Blood (trauma)
4. Foreign bodies
5. Laryngeal obstruction
   a) oedema from burns
   b) inflammation
   c) anaphylaxis
6. Laryngeal spasm
   a) upper airway stimulation
   b) inhalation of FB
7. Below the larynx
   a) excessive bronchial secretion
   b) mucosal oedema
   c) bronchospasm
   d) pulmonary oedema
   e) aspiration of gastric contents
8. Extrinsic compression of airway
   a) trauma
   b) haematoma
   c) malignancy

Question 2

How do you recognise an airway obstruction?

Answer 2

LOOK, LISTEN and FEEL approach

• Look for chest and abdominal movements
• Listen and feel for airflow at the mouth and nose

Question 3

What happens in partial airway obstruction?

Answer 3

Air entry is diminished and usually noisy.

1. Inspiratory stridor - obstruction at the laryngeal level or above
2. Expiratory wheeze - obstruction of the lower airways (which tends to collapse and obstruct during expiration)
3. Gurgling - the presence of liquid or semisolid foreign material in the upper airways
4. Snoring - arises when the pharynx is partially occluded by the tongue or palate
5. Crowing or stridor - is the sound of laryngeal spasm or obstruction

Question 4

How do you recognise complete airway obstruction?

Answer 4

1. ‘See saw breathing’ (Paradoxical chest and abdominal movement) - The chest is drawn in and the abdomen expands on inspiration
2. Accessory muscles of respiration are used
3. Intercostal / subcostal recession
4. Tracheal tug
5. Failure to inflate the lungs during attempted PPV (during apnoea).

Question 5

List 3 basic airway maintenance techniques

Answer 5

1. Head tilt
2. Chin lift
3. Jaw thrust

Question 6

List the potential problems associated with bag-mask ventilation

Answer 6

1. Ineffective tidal volumes

2. Gastric inflation with risk of regurgitation and pulmonary aspiration