Sign & symptoms

Sign & symptoms



* They are fairly nonspecific -





n Most common symtoms are cough , dyspnoea & voice change may be associated with local pain or dysphagia



n dyspnoea is the most important & when its progressive indicate imminent upper airway obstruction .



n Stridor



-It’s a cardinal sign of upper airways obstruction



-noisy breathing resulting from narrowing of larynx or trachea.



-High pitched (low pitched called stertor)



Types:



Its inspiratory , expiratory or biphasic



1 -Inspiratory when obst above the glottic level



2 -Exp. Obst wih intrathoracic airway



3 -Biphasic in tracheal lesions.



4-Extrathoracic airway tend to collapse during



& the oppsits for intrathoracic airway due to effect of inrta pleural pressure.



-Trachea is protected from these fluctuations during respiratory cycle by its cartilage rings







n Hoarseness



-Its abnormal vibration of vocal cords.



-Impaired vibration as a result of v.c paralysis , oedema , mucosal tears , laryngeal disrubtions or reduced airflow through the glottis



-The greater the degree of hoarseness the greater the risk of laryngeal damage



-Aphonea may occure in severe injury.







n Suprasternal retraction



-Accessory ms used to overcome obst like suprasternal retraction , intercostal recession & flaring of the nostrils.



n Restlessness



-May be the result of anxiety or hypoxia



-A patient showing restlessness & suprasternal recession requires urgent resp. support



n Drooling & bleeding



-Drooling the result of pain



-Pain is indicative of trauma or infection



-Bleeding is indicative of mucosal truama



n Fractures & subcutaneous emphysema



-# of trachea , larynx , maxilla & mandible sh be checked.







Assessment





n Exclude any immediately reversible cause of obstruction



n Resuscitation of breathing & circulation



n Full assessment of other injures & medical conditions



n If airway is stable but the underlying cause of obst. Is not obvious then further assessment may be warrented



n Most useful investigation is F.O examenation to site & extent of obst.



n Cervical x-ray in cervical injury



n Other radiographs may be needed neck , chest , facial views & arteriography



n Endoscopy in significant disrubtion of aerodigestive tract







Treatment
principles







n Below the lowest level of obstruction



n Careful consideration to pre or coexisting medical conditions



n Once airway adequately secured other medical conditions should be addressed



n The most straightforward & least invasive methode must be treated of choice







Medical management & Non invasive procedures







n The time to do tracheostomy is when you first think of it



n In minor trauma (infection or tumour) that cause moderate obstruction



n A period of close observation while supportive & therapeutic measures are started



n Trained staff are available



n The most appropriate place is ICU











MEDICAL MANAGEMENT







n Heimlich maneuver



-Used in laryngeal obstruction by a food bolus



-Uses the residual air in the lungs to expel the bolus from the glottis



-If fail cricothyroidotomy sh be done



-complications:- pneumomediastinum & pneumo pericardium , surgical emphysema & gastric rupture & a period of observation before discharge is recommended







n Oxygen & heliox



-humidified O2 via face mask or nasal cannulae will help to relieve hypoxia



-helium has low density & high viscosity & so less prone to turbulent flow than air or O2



-Heliox is a mixture of 80% helium & 20% O2



-Heliox result in reduced airway resistent



n Steroids



-Have a significant rule in reduction of inflammatory , infective & traumatic oedema



-the main problem is with their underdosing rather than overdosing



n Antibiotics



- Given in suspected acute infection & mucosal inj



- High dose of penicillin i.v or cephalosporin







ULTERNATIVE AIRWAY







1-Oral airway



-Semi rigid used in loss of consciousness & nasal inj



-normal airway beyond oral cavity & nasopharynx



-It facilitates suction



-Used in conjunction with face mask & ambubag



2-Nasopharyngeal airway



-used when the problem at the level oforopharynx



-simple , easy to insert , soft & well tolerated







3-Endotracheal intubation



-When oral & nasopharyngeal airway is not appropriate or failed



-Incase that necessitate assisted ventilation



-In progressive obstruction



n Relative contraindication



1. Fracture of cervical spine(injury)



2. Sever facial trauma :bleeding , swelling , trismus , mucosal injury & bony instability



3. Laryngeal trauma







n When transoral felt transnasal attempted under endoscopic control



n Tip of endoscope is passed into trachea & the tube is then passed