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Acute Airway Obstruction

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First step of resuscitation is to ensure airway intact

About

Sudden onset: Foreign body aspiration, anaphylaxis
Slow onset: malignancy, inflammatory
Wheeze: expiratory
Stridor: Inspiratory

Causes

Cause of Airway Obstruction	Description	Management
Asthma	Chronic inflammatory disorder of the airways. Characterized by reversible airway obstruction, bronchoconstriction, and airway hyperresponsiveness. Symptoms include wheezing, shortness of breath, chest tightness, and coughing.	Inhaled bronchodilators (e.g., salbutamol/albuterol) for quick relief. Inhaled corticosteroids for long-term control. Leukotriene modifiers, long-acting beta-agonists (LABAs), and oral corticosteroids. Avoidance of triggers (allergens, irritants).
Chronic Obstructive Pulmonary Disease (COPD)	Progressive and chronic inflammatory lung disease. Characterized by irreversible airway obstruction due to chronic bronchitis and emphysema. Symptoms include chronic cough, sputum production, and dyspnoea.	Inhaled bronchodilators (e.g., beta-agonists, anticholinergics) for symptom relief. Inhaled corticosteroids for reducing exacerbations. Oxygen therapy for severe hypoxaemia. Smoking cessation, pulmonary rehabilitation, and vaccination (influenza, pneumococcal).
Foreign Body Aspiration	Inhalation of an object that obstructs the airway. Common in children and the elderly. Symptoms include sudden coughing, wheezing, choking, and stridor.	Heimlich maneuver for acute choking. Bronchoscopy to remove the foreign object. Supportive care, including oxygen therapy if needed.
Anaphylaxis	Severe, systemic allergic reaction that can lead to airway obstruction due to laryngeal edema. Triggers include foods, insect stings, medications. Symptoms include difficulty breathing, wheezing, swelling, hives, and hypotension.	Immediate administration of intramuscular adrenaline/epinephrine. Airway management (intubation if necessary). Antihistamines, corticosteroids, and bronchodilators for symptom control. Observation and monitoring for biphasic reactions.
Croup (Laryngotracheobronchitis)	Viral infection causing inflammation of the larynx, trachea, and bronchi. Common in young children, characterized by a "barking" cough, stridor, and hoarseness.	Humidified air or oxygen therapy. Nebulized epinephrine for severe cases. Dexamethasone or other corticosteroids to reduce inflammation. Monitoring for respiratory distress and hospitalization if needed.
Epiglottitis	Acute inflammation of the epiglottis, often caused by bacterial infection (e.g., Haemophilus influenzae type B). Symptoms include severe sore throat, drooling, stridor, and difficulty swallowing. A medical emergency due to the risk of sudden airway obstruction.	Immediate airway management, often intubation in a controlled setting. Intravenous antibiotics (e.g., ceftriaxone or cefotaxime). Intravenous corticosteroids to reduce inflammation. Hospitalization and close monitoring in an ICU setting.
Lung Cancer	Malignant growth that can cause airway obstruction through tumour invasion or compression. Symptoms include persistent cough, haemoptysis, wheezing, and dyspnoea.	Surgical resection for localized tumours. Chemotherapy and/or radiation therapy for non-resectable tumours. Bronchoscopy with stent placement to relieve obstruction. Palliative care for advanced stages to manage symptoms.
Tracheal Stenosis	Narrowing of the trachea due to scarring, inflammation, or congenital causes. Symptoms include difficulty breathing, stridor, and recurrent respiratory infections.	Tracheal dilation or stenting to open the airway. Laser therapy or surgical resection in severe cases. Management of underlying causes (e.g., infection, inflammation).

Other causes

Luminal
- Dentures, food bolus in mouth e.g. steak
- Facial fractures e.g. Fractured mandible
- Enlarged tongue - angioedema with alteplase, bleeding into tongue
- Foreign body
- Tumour - laryngeal cancer, lung cancer
- Haemorrhage
- Mucus plugs
- Trauma to airway
- Bilateral vocal cord palsy
Mural
- Oedema: Local Trauma or Anaphylaxis
- Haemorrhage and haematoma: trauma, post Thyroid op
- Pus: Abscess, Epiglottitis
- Enlarged tonsils
- Laryngeal stenosis
- Laryngeal oedema
- Laryngospasm
- Bronchospasm - asthma and mucus plugs
Outside the airway
- Retropharyngeal abscess
- Large goitre
- Obesity
- Anaphylaxis
- Haemorrhage around neck

Anatomy

Clinical

Respiratory distress
Cyanosis, shock
Respiratory arrest

Head tilt and chin lift

Adjuncts:Nasopharyngeal airway

Adjuncts:Guedel airway

Adjuncts:Considering Front of Neck Airway

Management

Luminal obstruction suspected: Finger sweep if suspected intraluminal obstruction. Leave dentures in place.
Choking algorithm: If still standing and choking try Hitting in back and then Heimlich manoeuvre. 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.
Anaphylaxis algorithm if appropriate. IV access. IM Adrenaline 0.5 mg IM
Unconscious breathing and pulse. If not breathing start CPR
- Ensure chin lift and jaw thrust and inspect mouth and oropharynx
- Give high flow Oxygen. Recovery position and monitor
- Consider Guedel and/or nasopharyngeal airways
Failing to oxygenate
- Manually ventilate with ambu bag and 100% Oxygen
- Prepare to intubate and ventilate

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