Critical Care Pearls
• Upper airway obstruction (UAO) is a life-threatening emergency that requires prompt
diagnosis and treatment.
• Severe UAO can be surprisingly asymptomatic at rest if it develops gradually. Sudden
clinical deterioration is unpredictable.
• Patients with possible UAO must never be sedated until the airway is secured. Minimal
sedation may precipitate acute respiratory failure.
• Achievement of airway patency in total airway obstruction and reestablishment of ventilatory airflow is the first and foremost goal of the treating physicians.
• Critical care physicians must be aware that pharmacologic interventions (epinephrine,
steroids, and heliox) provide temporary support but cannot significantly improve
mechanical UAO.
• Bronchoscopy constitutes the most accurate diagnostic tool and frequently provides the
best way to correct UAO.
• Cricothyroidotomy is the surgical intervention of choice to reestablish airflow when
medical interventions have failed.
Clinical Signs and Symptoms:
*In a conscious patient,
signs and symptoms of UAO include
1. marked respiratory distress,
2.altered voice
3. dysphagia
4. odynophagia
5. the hand-to-the-throat choking sign
6. stridor
7. facial swelling
8. prominence of neck veins
9. absence of air entry into the chest
10. tachycardia
*In an unconscious or sedated patient,
1. the first sign of
airway obstruction may be inability to ventilate
with a bag-valve mask after an attempt to open
the airway with a jaw-thrust maneuver.
2. After a few minutes of complete airway obstruction,
asphyxiation progresses to cyanosis, bradycardia, hypotension, and irreversible cardiovascular collapse.
B.Investigations:
1.Plain Chest and Neck Radiographs.
2.Spirometry
3.Bronchoscopy
4.Computed Tomography
5.LARYNGOSCOPY
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• Upper airway obstruction (UAO) is a life-threatening emergency that requires prompt
diagnosis and treatment.
• Severe UAO can be surprisingly asymptomatic at rest if it develops gradually. Sudden
clinical deterioration is unpredictable.
• Patients with possible UAO must never be sedated until the airway is secured. Minimal
sedation may precipitate acute respiratory failure.
• Achievement of airway patency in total airway obstruction and reestablishment of ventilatory airflow is the first and foremost goal of the treating physicians.
• Critical care physicians must be aware that pharmacologic interventions (epinephrine,
steroids, and heliox) provide temporary support but cannot significantly improve
mechanical UAO.
• Bronchoscopy constitutes the most accurate diagnostic tool and frequently provides the
best way to correct UAO.
• Cricothyroidotomy is the surgical intervention of choice to reestablish airflow when
medical interventions have failed.
Clinical Signs and Symptoms:
*In a conscious patient,
signs and symptoms of UAO include
1. marked respiratory distress,
2.altered voice
3. dysphagia
4. odynophagia
5. the hand-to-the-throat choking sign
6. stridor
7. facial swelling
8. prominence of neck veins
9. absence of air entry into the chest
10. tachycardia
*In an unconscious or sedated patient,
1. the first sign of
airway obstruction may be inability to ventilate
with a bag-valve mask after an attempt to open
the airway with a jaw-thrust maneuver.
2. After a few minutes of complete airway obstruction,
asphyxiation progresses to cyanosis, bradycardia, hypotension, and irreversible cardiovascular collapse.
Exams & Investigations:
A.Physical examination may show:
- Decreased breath sounds in the lungs
- Rapid, shallow, or slowed breathing
B.Investigations:
1.Plain Chest and Neck Radiographs.
2.Spirometry
3.Bronchoscopy
4.Computed Tomography
5.LARYNGOSCOPY
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