Upper Airway

Obstruction
The Upper Airways
The major passages and
structures of the upper
respiratory tract include
the nose or nostrils, nasal
cavity, mouth, throat
(pharynx), and voice box
(larynx).
Pharynx Nasal Cavity

Larynx
 Definition
An airway obstruction is a
blockage in any part of the
airway. The airway is a
complex system of tubes
that transmits inhaled air
from your nose and mouth
into your lungs. An
obstruction may partially or
totally prevent air from
getting into your lungs.
Pathophysiology
Anatomy-related obstruction
When mouth is at
rest:
Tongue should be
against the roof of
the mouth, but it
should not be
pressing against any
of the teeth
Teeth should be
slightly apart, and
lips should be closed.
Anatomy-related obstruction
A relaxed tongue is the most
common cause of upper airway
obstruction in patients who are
unconscious or who have suffered
spinal cord or other neurological
injuries.
The tongue may relax into the
airway, causing an obstruction. In
some cases, other injuries
complicate this phenomenon.
Foreign Bodies
The most common cause of airway
obstruction in children is a foreign
body lodged in the airway.
Choking can fully or completely
obstruct the airway. Small toys,
round foods such as berries and
grapes, rocks, pebbles, and other
enticing objects are common
culprits. Eighty-eight percent of
airway obstruction deaths occur in
children younger than four.
Foreign Bodies
Swelling
Swelling

Swelling can obstruct the

airway in a matter of seconds.
Though infections can cause
severe upper airway swelling,
the most common cause is
anaphylaxis.
Croup caused by a virus that
makes their airways swell
Infection
Infections such as pneumonia, RSV,
and even colds may obstruct the
upper airway. Children are more
vulnerable because of their smaller
airways. In newborns, upper airway
obstructions, even partial ones, are
particularly dangerous because
newborns breathe through the
nose. People with chronic
respiratory diseases such as COPD
also face a higher risk of infectious
upper airway obstructions.
Trauma

Traumatic injuries can directly

obstruct the airway, such as
when a gunshot or knife wound
collapses portions of the
airway. Trauma can also cause
continuous bleeding or vomiting
that obstructs the airway,
making airway management
difficult and increasing the risk
of aspiration pneumonia.
Trauma
Trauma
 Clinical Manifestations
The signs and symptoms of an airway obstruction depend on the cause but some
symptoms are common to all types of airway blockage.

Cardio-respiratory Neurologic
manifestations manifestations

cyanosis (bluish-colored skin)

agitation
alterations in normal breathing pattern
confusion
difficulty breathing or no breathing
gasping for air
high-pitched breathing noises called stridor
panic
decreased breathing sounds in the lungs
unconsciousness
cardio-respiratory arrest
 Diagnostic
Procedures
Upper airway obstruction is a potentially
fatal condition that requires prompt
diagnosis and treatment.
X-ray or CT Scan
Chest X-ray

Chest Computated Tomography

(CT Scan)
BRONCHOSCOPY
 Medical
Management
Series of evidenced-based interventions
that involves both medical,
pharmacological, and surgical
interventions used to manage upper
airways obstructions
Quick history and clinical examination can help in
determining the site of obstruction.

Establishing a secure and patent airway is the most

important goal in the resuscitation of a patient with
acute Upper airway Obstruction.
Oropharyngeal Airways
An oropharyngeal airway (oral airway,
OPA) is an airway adjunct used to
maintain or open the airway by stopping
the tongue from covering the epiglottis.
In this position, the tongue may prevent
an individual from breathing.
Endotracheal Intubation
Endotracheal intubation is a medical
procedure in which a tube is placed
into the windpipe (trachea) through
the mouth or nose. In most
emergency situations, it is placed
through the mouth.
 Epinephrine
Is used for temporary relief of
symptoms associated with bronchial
asthma (e.g., shortness of breath,
chest tightening, wheezing) and to
treat croup in children.
 Corticosteroids
Corticosteroids are the most effective drugs to
suppress airway inflammation, mainly by
downregulation of pro-inflammatory proteins
Helium-oxygen mixture
Heliox is a mixture of helium and oxygen used for inhalation. This
agent is thought to improve airflow by creating gas with similar
viscosity to air but with lower density, which in turn can increase
ventilation and decrease work of breathing.Breathing heliox
leads to a reduction in resistance to flow within the airways, and
consequently to a decrease in the work of breathing (WOB),
particularly in disorders that are characterized by increased
airways resistance.
 Heimlich Maneuver
Heimlich maneuver is recommended for relief of the airway obstruction
in adults and children one to 8 yrs of age. Otherwise known as
Subdiaphragmatic abdominal thrust can force air from the lungs; this
may be sufficient to create an artificial cough and expel a foreign body
from the airway.
 How to perform?
Get the person to stand up.
Position yourself behind the person.
Lean the person forward and give five blows to their back with the heel
of your hand.
Place your arms around their waist.
Make a fist and place it just above the navel, thumb side in.
Grab the fist with your other hand and push it inward and upward at the
same time. Perform five of these abdominal thrusts.
Repeat until the object is expelled and the person can breathe or cough
on their own.
Managing hypopharyngeal
obstructions
To relive obstructions caused by anatomical related
obstructions like tongue, a series of simple maneuvers can
be done.
A) A hypopharyngeal obstruction occurs when neck flexion
permits the chin to drop toward the chest; obstruction almost
always occurs when the head is in the midposition.

B) Tilting the head back to stretch the anterior neck structure lifts
the base of the tongue off the posterior pharyngeal wall. The
direction of the arrows indicates the pressure of the hand
C) Opening the mouth is necessary to correct valvelike
obstruction of the nasal passage during expiration, which occurs
in about 30% of unconscious patients. Open the patient’s mouth
(separate lips and teeth) and move the lower jaw forward so that
the lower teeth are in front of the upper teeth. To regain backward
tilt of the neck, lift with both hands at the ascending rami of the
mandible
 Medical Management
Surgical intervention which formed the most important part of treatment in
severe emergency
Fiberoptic intubation
cricothyroidotomy
Tracheostomy
Airway stenting
 Nursing Management
Maintaining patent airway is always the first priority, especially in cases like
trauma, acute neurological decompensation, or cardiac arrest.

Teach the patient the proper ways of coughing and breathing. (e.g., take a deep
breath, hold for 2 seconds, and cough two or three times in succession).

Maintain an elevated head of bed as tolerated to help prevent secretions from

accumulating. Sliding down in the bed or a slumped posture prevents proper lung
expansion.
 Nursing Management
Encourage patient to increase fluid intake to 3 liters per day within the limits of
cardiac reserve and renal function.

Provide oral care every 4 hours.

Educate patient on coughing, deep breathing, and splinting techniques.

Provide patient understanding about the proper use of prescribed medications

and inhalers.
 Health Teaching
Always supervise young children when they are eating. Make sure they sit
down when they have food in their mouths.
Keep small items that are a choking hazard out of children's reach. Check
under your furniture and between seat cushions for choking hazards.
Consider buying a small parts tester to help determine which items are
choking hazards.
Make sure your child plays with age-appropriate toys.
Check toys regularly for damage.
Be aware that foods account for more than half of airways
obstructions. Keep the following foods away from children
younger than 4 years
Remove hood and neck drawstrings from young children's
outerwear.
Don't allow children to wear necklaces, purses, scarves, or
clothing with drawstrings on playground equipment.
Tie up or cut all window blind and drapery cords.
Don't hang anything over the crib that has cords or ribbons
longer than 7 inches.
Don't let children under age 6 sleep on the top bunk of bunk
beds.
Don't let your child play on bean bag chairs that contain small
foam pellets.
Don't let young children play with shooting toys.
Remember to discard any plastic wrapping the toy came in.