First step of resuscitation is to ensure airway intact
About
- Sudden onset: Foreign body aspiration, anaphylaxis
- Slow onset: malignancy, inflammatory
Clinical
- Wheeze: expiratory
- Stridor: Inspiratory
- Tumour
- Foreign body
- Bilateral vocal cord palsy
- Laryngeal oedema
- Thyroid goitre
- Respiratory distress
- Cyanosis, shock
- Respiratory arrest
Extrathoracic
- Oropharynx: Enlarged tonsils, Retropharyngeal abscess, Obesity, foreign body - food
- Larynx: Laryngeal oedema, Laryngeal stenosis, Epiglottitis, Anaphylaxis, laryngospasm, food bolus e.g. piece of steak
Intrathoracic
- Trachea: Tracheal stenosis, foreign body, tracheomalacia, tumour, aspiration, Goitre, Right-sided aortic arch
- Airways: Asthma - bronchospasm + plugging, COPD, Malignancy with bronchostenotic lesion
Management
- If still standing and choking try Hitting in back and then Heimlich manouvre. This is used to expel an inhaled foreign body. Stand behind the patient. Encircle the upper part of the abdomen, just below the patient’s rib cage, with your arms. Give a sharp, forceful squeeze, forcing the diaphragm sharply into the thorax.
- Unconscious or on floor. Ensure chin lift and jaw thrust and inspect mouth and oropharynx
- Measure O2 saturations. Give high flow Oxygen and start CPR if not breathing
- Anaphlyxis and oedema affecting airways: IM Adrenaline 0.5 mg IM and Steroids for anaphylaxis. Chlorphenamine 10 mg by slow IV injection or IM. Hydrocortisone IV 100 mg slowly. Give O2
- Get anaesthetic help if airway obstructed