- Airway obstruction can occur suddenly or insidiously.
- Prompt identification and management usually averts disaster.
- It is important to closely evaluate at-risk patients.
- An alert patient with any degree of airway obstruction will have audible abnormal breathing sounds, become visibly more agitated and assumes the posture (usually upright) that enables them to breathe.
- However, the patient with altered mental state may obstruct quietly and fatally unless specific attention is given to the patient. The usual mistake is to not carefully monitor the at-risk patient.
- Mechanical obstruction e.g. foreign body, expanding neck abscess (also see Pathology of Any Hollow Tube)
- Functional obstruction e.g. coma with loss of airway tone
- Any patient with symptoms referable to oral-pharnyx or neck AND features of an Acute Process
- Any patient with trauma to the oral-pharynx or neck (See Not all Trauma is Physical Trauma)
- Any patient with depressed conscious state
- Choking sensation when lying flat
- Upper airway noises – stridor, stertor
Depends on the expected trajectory of the disease and how quickly it will respond to treatment e.g. croup post steroid versus coma after polypharmacy overdose
- Get help early if the obstruction is severe or rapidly progressing
- Don’t upset the patient (especially children). Agitation alters pattern of breathing, worsens pressure-flow dynamics, collapses the airway and increases work of breathing. It may even precipitate complete obstruction
- Don’t examine or instrument the airway without expert backup
- Allow the (alert) patient assume the posture they feel comfortable with
- Unconscious patients may need simple airway manoeuvre
- Secure the airway if it is anticipated that obstruction is likely to progress quickly
- Treat the underlying process e.g. antibiotics for infection