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2/17/2017 rrapid.leeds.ac.uk/pRRAPID/03airway06.

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A
Airway
COMMONCAUSESOFAIRWAYOBSTRUCTION
Anobstructedairwaypreventsthepassageofoxygentothelungsleadingrapidlytohypoxiaandpotentially
cardiacarrest.

Functionalairwayobstructionmaybepartialorcompleteandoccuratanypointfromthelevelofthe
mouth/nosedowntotheendofthetrachea(atthelevelofthecarina).Airwayobstructioncommonlyoccurs
inpatientswithareducedconsciouslevelduetoaspiration.Itcanalsocommonlyoccurinchildrenasa
resultofobstructionasaresultof:

internalobstruction(foreignbody,enlargedtonsils,retropharyngealabscess)
externalcompression(vascularring,mediastinaltumour)or
inflammationoroedemaoftheairwayitself(croup,anaphylaxis,airwayburns).

Upperairwayobstructioncanbeheardasstridor,aharshinspiratorynoise(differentfromwheezewhichis
ahighpitchedexpiratorysoundasaresultoflowerairwayobstruction).

Reducedconsciouslevel:Patientswhohaveadepressedlevelofconsciousnessmayfinditdifficultto
maintaintheirownairway.Softtissues(tongue,softpalateandepiglottis)mayoccludetheupperairwayas
canaspirationofstomachcontents.ConsciousstatecanbeassessedusingtheAVPUscoreorGlasgow
ComaScore(GCS),whichisdiscussedlater.Inthesepatientsitisimportanttoprotecttheairwayusing
airwaymanoeuvresoradjunctsuntiladefinitiveairway(endotrachealtube)canbeestablished.Seizure
activityisoftenassociatedwithairwayocclusion.

Secretionsintheairway:Inapatientwithreducedconsciousnessandacompromisedairway,secretions
orvomitmayprecipitateairwayobstruction.Insuchcases,placingthepatientintherecoverypositionand
gentlesuctionishelpful.

Anaphylaxis:Asevere,lifethreateningallergicreactionduringwhichoedemaofthelarynxandupperand
lowerairwaysmaycauseobstruction,makingbreathingextremelydifficult.Theremayberash,stridor,
wheezeand/orshock.Treatmentincludesantihistamines,steroidsandadrenaline.

Softtissueswelling:Swellingoftheairwaycanoccurduetoinfection(e.g.croup,epiglottitis,supraglottitis)
ortraumasuchasburnsandinhalationalinjury.Themanagementofthesecanbedifficultandearly
involvementofananaesthetistiscrucial.Steroidsincludingdexamethasoneandbudesonideareoftenused.

Foreignbodyobstruction:Thisiscommoninchildrenbetweentheagesof1and3.Thereisusuallya
historyofsuddenonsetdifficultyinbreathingandoftenanassociatedchokingepisode.Theyusuallyhave
unilateralsignsonexaminationandintoddlersitisimportanttoalwaysconsiderinhaledforeignbodyina
youngchildpresentingwithairwayobstruction.

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