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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
- endotracheal intubation [3]
- surgical airway
- cricothyrotomy with 12-16 gauge over-the-needle catheter
- BIPAP has no role in management of upper airway obstruction [3]
General
obstruction
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 184-85, 188
- Eskander A, de Almeida JR, Irish JC.
Acute upper airway obstruction.
N Engl J Med. 2019;381:1940-49.
PMID: 31722154
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025