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4 - Critical Care

Published online by Cambridge University Press:  12 August 2009

Wendy Adams
Affiliation:
Royal Victoria Infirmary, Newcastle
Jonathan Bull
Affiliation:
St Mary's Imperial College BST, London
Jonathan Epstein
Affiliation:
Christie Hospital, Manchester
Anant Krishnan
Affiliation:
University of Cambridge
Leon Menezes
Affiliation:
Guy's and St Thomas' Hospitals, London
Bijan Modarai
Affiliation:
Guy's and St Thomas' Hospitals, London
Paul Patterson
Affiliation:
North Tyneside General Hospital, Newcastle
Arun Sahai
Affiliation:
Guy's and St Thomas' Hospitals, London
Alexis Schizas
Affiliation:
Guy's and St Thomas' Hospitals, London
Reuben Johnson
Affiliation:
University of Oxford
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Summary

AIRWAY ISSUES

Airway Obstruction

How would you define airway obstruction?

Partial or complete occlusion of the upper or lower respiratory tract, upper airway obstruction being more common than obstruction below the larynx.

In what situations does it occur?

Upper airway obstruction commonly occurs in the unconscious patient who is unable to maintain there airway due to the tongue falling backward. Other causes of upper airway obstruction include: laryngospasm, tumours, soft tissue swellings, oedema, infection (epiglottitis and diphtheria) and foreign objects as well as blood and vomit. In anaesthesia; lower airway obstruction may occur due to pulmonary secretions or mucus plugging, pulmonary oedema, pneumothorax or haemothorax.

What are the clinical features of airway obstruction?

  • Hypoventilation.

  • Increased work of breathing: accessory muscles of breathing are often employed, tracheal tug may be seen, see-saw paradoxical movement of the abdomen and the chest may also be noticeable.

  • Change in noise of breathing: complete obstruction is silent; partial obstruction is noisy (e.g. stridor).

  • Tachypnioea.

  • Tachycardia.

  • Lower respiratory signs will be present if there is lower airway obstruction, but this will depend on the cause of the lower airway obstruction.

How would you clinically assess an airway?

  • Look: for accessory muscle movements, see-saw movements of abdomen and chest, foreign bodies in airway; and in late stages central cyanosis.

  • Listen: for breath sounds, stridor, grunting and gurgling.

  • Feel: for airflow at the nose and mouth; chest movement.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2004

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