The immune and lymphatic systems, infection and sepsis
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
Airway patency can be compromised due to rapidly swelling deep tissues of the mucus membranes and lips known as angioedema. Swelling of the tongue associated with oropharyngeal and laryngeal oedema may also threaten the airway. The patient’s ability to swallow their own saliva should be assessed, and the development of a hoarse voice indicates partial airway obstruction. High-pitched inspiratory noise or stridor is caused by upper airway obstruction and should be immediately recognised and dealt with by summoning urgent help via the peri-arrest or cardiac arrest call systems. Under the direction of the medical team, intramuscular adrenaline and other pharmacology agents should be urgently administered. Worsening signs of airway obstruction include: Swelling of tongue and lips.Hoarseness.Oropharyngeal swelling.
Paediatric Emergencies
Anthony FT Brown, Michael D Cadogan in Emergency Medicine, 2020
Complete airway obstruction Hold an infant or small child head down and deliver up to five blows to the back between the shoulder blades, followed by up to five chest thrusts.Perform abdominal thrusts after the back blows in an older child, but not in infants <1 year.Attempt removal of the impacted object under direct vision using a laryngoscope and a pair of long-handled forceps if the above measures fail, and the patient is unconscious, orProceed directly to emergency cricothyroid puncture (see p. 467).
Acute respiratory insufficiency
Louis-Philippe Boulet in Applied Respiratory Pathophysiology, 2017
The treatment of upper airway obstruction depends on its etiology. A foreign body can be removed by an energetic external compression of the diaphragm such as the one performed during the Hemlich maneuver. It could, similar to a lesion causing a partial obstruction, be extracted by bronchial endoscopy or during open surgery [3]. Extrinsic bronchial compressions, according to their etiology and the time available for the intervention, will be treated with bronchial dilatation, insertion of a tutor, or surgical intervention. Endoluminal or extrinsic neoplastic lesions affecting the airways subacutely or chronically may also benefit, according to the case, from radiotherapy or chemotherapy.
A computational model of upper airway respiratory function with muscular coupling
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Olusegun J. Ilegbusi, Don Nadun S. Kuruppumullage, Matthew Schiefer, Kingman P. Strohl
The model predicts a decrease in the pharyngeal luminal opening from the standing position to the supine position, which results in a reduction in the pressure in the laryngopharynx. This results in an increase in the resistance to the airflow which correlates with the relevant anatomical changes and outcomes relevant to patients with obstructive sleep apnea. We have also assessed the dimensional variations in the upper airway in three different longitudinal sections along the airway namely the tongue level, the epiglottis level, and the larynx level. Out of these three, in this formulation, the epiglottis section exhibits the smallest opening in all three cases considered. This result suggests a possible new location for airway obstruction, which may be examined for its impact on clinical treatment. In the supine position, the narrowing of the airway results in the higher-pressure differential between the internal pressure and the external pressure imposed by the weight of the surrounding tissues, which makes the upper airway behave like a collapsible vessel.
Prehospital Manual Ventilation: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
John W. Lyng, Francis X. Guyette, Michael Levy, Nichole Bosson
Airway obstruction frequently occurs in the unconscious or obtunded patient due to decreased muscular tone in pharyngeal muscles and consequent obstruction at the level of the soft palate, posterior oropharynx, epiglottitis, and tongue (44, 45). Therefore, BVM technique also involves simultaneous positioning of the head and neck to open the airway structures. The basic maneuvers to establish an airway include putting the patient in the “sniffing position” to align the three important airway axes (mouth, laryngeal, and pharyngeal). Safar found that neck flexion obstructed the airway in 80 anesthetized, spontaneously breathing patients; and neck extension (chin up) position achieved patency in 50% of this group, while the other 50% required either anterior displacement of the mandible, insertion of an oral airway, or both to achieve airway patency (46). Boidin showed that epiglottic obstruction was common and could be overcome by anterior displacement of the hyoid with elevation of the occiput in a range from 4 cm to 8 cm above horizontal, with head tilt contributing less relief of obstruction than elevation of the occiput (45) .
Anesthetic consideration for airway management in patient undergoing tracheal resection and reconstruction for severe postintubation tracheal stenosis: a case report
Published in Postgraduate Medicine, 2021
Yi Chen, Hong Liao, Yuanyuan Niu, Xinli Ni, Jianzhen Wang
Postintubation tracheal stenosis (PITS) is one of the most common risk factors for benign airway obstruction. The incidence of benign airway obstruction is relatively low compared to malignant airway obstructions [1]. Common symptoms of severe PITS include exertional dyspnea, shortness of breath, stridor, and voice changes [2]. PITS may occur with prolonged intubation, excessive endotracheal tube cuff pressure, trauma during intubation, or infection. Despite technological innovations and increased levels of anesthetic care, nursing, and intensive care, this iatrogenic complication remains difficult to avoid in clinical practice [3]. Standard treatments include therapeutic endoscopy and surgical tracheal resection and reconstruction (TRR), which have favorable outcomes. Here, we report a case involving a patient with severe PITS after partial pericardiectomy with a principal diagnosis of tuberculous constrictive pericarditis.
Related Knowledge Centers
- Croup
- Laryngitis
- Respiration
- Respiratory Tract
- Tracheitis
- Vocal Cords
- Paralysis
- Foreign Body Aspiration
- Injury
- Epiglottitis