Airway Threat

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Choke
Introduction

  • 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.

Causes

  • 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

At-risk patients

  • 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

Management
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

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