upper airway obstruction

Etiology: 1) trauma to face & neck 2) foreign body 3) infection a) croup b) epiglottitis c) Ludwig's angina d) retropharyngeal abscess e) diphtheria 4) tumor 5) angioedema 6) laryngospasm 7) anaphylaxis 8) retained secretions 9) blockage of upper airway by tongue in unconscious patient 10) inhalation injury a) ammonia b) hydrochloric acid c) chlorine d) cadmium e) zinc chloride f) osmium tetroxide g) paraquat 11) vocal cord paralysis or dysfunction Clinical manifestations: 1) general manifestations - stridor, may be both inspiratory & expiratory - impaired or absent phonation - sternal or suprasternal retractions - signs of choking - respiratory distress - apnea in unconscious patient 2) features which may be present depending upon etiology - urticaria - angioedema - fever - evidence of trauma Special laboratory: 1) pulmonary function testing - flow-volume loop shows inspiratory or expiratory plateau or both 2) indirect laryngoscopy 3) nasopharyngolaryngoscopy Radiology: - soft tissue radiographs of neck (posteroanterior & lateral) Management: 1) airway obstruction in awake patient without ventilation - Heimlich maneuver 2) unconscious patient without ventilation - head tilt-chin lift if cervical spine injury is not suspected to move tongue forward away from airway - jaw thrust if cervical spine trauma suspected - oral or nasal airway - bag-valve mask apparatus - blind finger sweep (risk of further pushing obstruction down airway) - supine Heimlick maneuver - surgical airway - cricothyrotomy with 12-16 gauge over-the-needle catheter

References

Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 184-85, 188