Acute upper airway obstruction

Definition

• A blockage of the upper airway, which can be in the trachea, laryngeal (voice box), or pharyngeal (throat) areas.

• The blockage can be complete or partial

partial obstruction

Mild obstruction may result in air hunger.

The patient with partial obstruction exhibits diminished tidal exchange that is associated with retraction of the upper chest and accompanied by a snoring sound if the obstruction is nasopharyngeal, inspiratory stridor if obstruction is near the area of the larynx .

Complete obstruction

• Complete obstruction can lead to cyanosis and confusion or unconsciousness, if not corrected, leads to rapid suffocation and death.

• The patient with complete obstruction exhibits no tidal exchange that is associated with paroxical breathing sound .

• Symptoms of acute upper airway obstruction are dramatic and easy to diagnose.

• The individual may suddenly begin having

difficulty breathing or be unable to breathe at all.

• Cyanosis, unconsciousness, and death may rapidly follow significant partial or total obstruction.

Common causes of acute upper airway obstruction

• Foreign bodies • Anaphylaxis • Croup• Infection diseases

Foreign bodies

• In adults, foreign bodies are usually aspirated chunks of meat or food.

• In children, peanuts are the most commonly aspirated food, but hot dogs are the most common food item associated with aspiration fatalities, because of their size and shape.

• Children also aspirate or choke on many nonfood items. Airway obstruction from aspirated balloon fragments, buttons, coins, and small toys is common.

Anaphylaxis

• Acute allergic reactions in which the trachea and/or throat swell closed are a common cause of airway obstruction.

• The classic example is an allergic reaction to a bee sting, which frequently takes the form of an anaphylactic reaction.

• Other common causes include allergy reaction to peanuts, antibiotics (penicillin), and blood pressure medications (group called ACE inhibitors).

Croup

• Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway.

• The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness.

Infection diseases

• 1. acute bacterial epiglottitis can cause rapid airway obstruction as the epiglottis swells and occludes the airway.

• 2. Retropharyngeal abscess a rapidly expanding abscess can block the airway and cause respiratory distress.

• 3. Peritonsillar abscess

Symptoms of Acute upper airway obstruction

Symptoms vary depending on the cause, but some symptoms are common to all types of obstruction.• Choking• Gasping for air • Wheezing, crowing, whistling, or other unusual breathing noises indicating breathing difficulty • Agitation• Panic • Cyanosis (bluish discoloration of skin caused by lack of oxygen) • Changes in consciousness • Unconsciousness

Signs and tests

• Physical examination may show decreased breath sounds.

• Tests are usually not necessary, but may include X-rays, bronchoscopy, and laryngoscopy.

Treatment • If the victim has a complete obstruction and is unable to speak or

breath, the Heimlich maneuver may be lifesaving .

• Esmarch’s maneuver : opens the airway by tilting the head backward, retracting the patient’s lower lip (with the rescuer’s thumbs) and by forceful forward displacement of the mandible (triple airway maneuver).

• Treatment depends on the cause of the blockage. Aspirated objects may be able to be removed with laryngoscopy or bronchoscopy.

• A tube may need to be inserted into the airway (endotracheal tube or nasotracheal tube). Sometimes an opening needs to be made directly into the airway (tracheostomy or cricothyrotomy).

Heimlich maneuver

Esmarch’s maneuver

Complications

• Inability to relieve the obstruction can cause breathing failure, brain damage, or death.