upper airway obstruction

Etiology

• trauma to face & neck
• foreign body
• infection
  • croup
  • epiglottitis
  • Ludwig's angina
  • retropharyngeal abscess
  • diphtheria
• tumor
• angioedema
• laryngospasm
• anaphylaxis
• retained secretions
• blockage of upper airway by tongue in unconscious patient
• inhalation injury
  • ammonia
  • hydrochloric acid
  • chlorine
  • cadmium
  • zinc chloride
  • osmium tetroxide
  • paraquat
• vocal cord paralysis or dysfunction

Clinical manifestations

• 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
• features which may be present depending upon etiology
  • urticaria
  • angioedema
  • fever
  • evidence of trauma

Diagnostic procedures

• pulmonary function testing
  • flow-volume loop shows inspiratory or expiratory plateau or both
• indirect laryngoscopy
• nasopharyngolaryngoscopy

Radiology

• soft tissue radiographs of neck (posteroanterior & lateral)

Management

• airway obstruction in awake patient without ventilation
  • Heimlich maneuver
• 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

More general terms

• obstruction