DEFINITION
A life threatening condition where there is complete, partial or potential obstruction of the airway at some point between the teeth and the Carina. The degree of obstruction and the speed of onset will vary depending on the cause.
CAUSES
1. The Patent's Tongue - this occurs in unconscious patients who are unable to maintain airway potency
2. Foreign Body - usually occurs in one of three clinical situations
- Patients with a decreased level of consciousness and a diminished cough reflex who inhale a foreign body
- Young children inhaling objects / material that they have put into their mouths
- Older patients with dentures who lack the ability to sense the size of the food bolus they are about to swallow
3. Upper Airways Swelling - due to infection /burns / trauma / o edema
CLINICAL FEATURES
Complete Obstruction
- no air movement present
- until the patient loses consciousness there will be :
grabbing at throat
paradoxical breathing with extreme respiratory distress
hypnosis
agitation
Partial Obstruction
- still some air movement present
- stride, cough, self posturing if the patient is conscious (GE sitting up, leaning forwards)
- use of accessory muscles of respiration
- hypnosis while breathing room air is a late sign of partial upper airway obstruction
Potential Obstruction
- normal air movement
- none of the above features
- swollen face, swollen tongue, sore throat, external neck trauma, circumferential neck burns, sooty sputum, burnt mouth / tongue / nasal hairs, history of fire or explosion in an enclosed space.
IMPORTANT POINTS
1. Hypnosis while breathing room air is a late sign of upper airway obstruction
2. Early upper airway swelling can be very subtle and initially have no clinical evidence of obstruction, yet dramatically obstruct later.
3. Skilled assistance is vital and the doctor most experienced in airway management should be summoned immediately.
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