Respiratory disorders: Upper Airway Disease

Question 1

Patients in respiratory distress often have exhausted their physiologic compensatory reserves for __________ and ___________.

Answer 1

Ventilation and oxygenation

Question 2

Prompt medical intervention for patients in respiratory distress includes -?

Answer 2

Oxygen supplementation, anxiolytics, and for some patients, intubation or tracheostomy

Question 3

True or False: Many patients do not present for emergency examination when their respiratory signs are subtle; therefore most patients with upper airway disease are evaluated once there has been progression to obstruction and respiratory distress.

Answer 3

True

Question 4

What can you expect to auscultate in the upper airways in patients with upper airway disease?

Answer 4

Loud, referred upper airway noise, which often can be localized to the point of maximal intensity

Question 5

What clinical signs can be observed with severe upper airway obstruction?

Answer 5

Extension of the head and neck, cyanosis of the tongue and MM, and collapse

Question 6

What opioid can be given to provide sedation, cough suppression, and analgesia? At what dosage?

Answer 6

Butorphanol, 0.1 - 0.5 mg/kg

Question 7

What medications (besides anxiolytics) can be administered, and what are indications for them, in patients in respiratory distress?

Answer 7

Acepromazine, if hemodynamically stable

Propofol, if sedation and anxiety control do not relieve distress

Glucocorticoids, to reduce airway inflammation secondary to obstruction

Other medications include other opioids and sedatives

Question 8

What diagnostics would be recommended for patients with upper airway disease, or presenting in respiratory distress?

Answer 8

Blood gas analysis, thoracic radiographs or other imaging modalities, a sedated laryngeal examination (can use Propofol, Ace, Butorphanol, Doxapram)

Question 9

What are examples of upper airway disease?

Answer 9

BAS
Nasopharyngeal polyps
Nasopharyngeal stenosis
Congenital choanal atresia
Nasopharyngeal FB and infection
Laryngeal paralysis
Inflammatory laryngeal disease
Tracheal collapse
Tracheal stenosis/ stricture
Tracheal FB
Neoplasia

Question 10

Complications of upper airway disease include?

Answer 10

Respiratory distress, hypoxemia, hypercarbia, hyperthermia, non-cardiogenic pulmonary edema, and aspiration pneumonia