upper airway obstruction
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Etiology
- trauma to face & neck
- foreign body
- infection
- tumor
- angioedema
- laryngospasm
- anaphylaxis
- retained secretions
- blockage of upper airway by tongue in unconscious patient
- inhalation injury
- 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
- 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]
More general terms
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: https://pubmed.ncbi.nlm.nih.gov/31722154
- ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025