Upper Airway Emergencies

Question 1

What structures make up the upper airway?

Answer 1

Question 2

Identify the anatomy of the upper airway

Answer 2

Question 3

Clinical Presentation: BOAS

Answer 3

Pharyngeal obstruction
Deep snoring stertor

Question 4

Clinical Presentation: Fixed Pharyngeal Obstruction

Answer 4

Stridor
High pitch musical whistling
The lower in the airway, the more stridorous and high pitched

Question 5

What are the 3 initial treatments to stabilize a patient in an upper respiratory crisis?

Answer 5

Active cooling to 103F
Sedate
Oxygen

Question 6

What is the diving reflex?

Answer 6

Cold air < cold water
Tolerance of hypoxemia and hypercapnia
Decreased ventilatory drive –> apnea
Bradycardia and vascoconstriction
Lessens dyspnea

Question 7

What is the vicious cycle of upper airway emergencies?

Answer 7

Question 8

What is the function of nebulized epinephrine?

Answer 8

Alpha-1 receptors vasoconstrict upper airway mucosa
Mitigates airway edema

Question 9

What are the indications for nebulized epinephrine?

Answer 9

Acute airway obstruction
Post extubation recovery

Question 10

Dose: Nebulized Epinephrine

Answer 10

0.05 mg/kg diluted in 5ml 0.9% NaCl
Deliver for 10 minutes

Question 11

Adverse Effects: Nebulized Epinephrine

Answer 11

Excitement
Nausea
Grey mucous membranes (normal)
Tremors
Tachycardia
Arrhythmias

Question 12

Dose + Timing: Corticosteroids

Answer 12

Dexamethasone SP 0.15 mg/kg IV
Up to 4-6 hours for effect on swelling

Question 13

What are the primary conditions associated with brachycephalic obstructive airway syndrome?

Answer 13

Stenotic nares, aberrant turbinates
Big, dense tongue
Elongated soft palate, thick
Hypoplastic trachea

Question 14

What is the appropriate exit strategy for a patient post-intubation for BOAS?

Answer 14

Decrease edema (cool patient, systemic steroids, dextrose compress)
Palatoplexy
Manage lung disease

Question 15

What are the consequences of BOAS?

Answer 15