upper airways obstruction

PENATALAKSANAAN

Upper Airway Obstruction (Obstruksi saluran Nafas Atas)

- Nose: hypertrophy concha,polyp- Nasopharynx- Oropharynx- Larynx

Upper Airways System

Anatomi (tonsil-adenoid)

Anatomy of Normal Larynx

Upper Airways Obstruction : Laryngeal obstruction, one of emergency

condition in ENT field

Hypoxia Apnea

DeathDeath

Clinical Features- Stridor- Airway obstruction, partial or severe- Repeated aspiration- Cyanotic or apnoeic attacks- Husky, weak or absent cry in infants- Husky voice in older children and adult- Atypical ‘pneumonia’ or ‘bronchitis’- Inhaled or ingested foreign body

Jackson Clasification 4 stadium

Stadium 1 : - Mild suprasternal retraction in inspiration - Inspiration stridor

Stadium 2 : - Deep suprasternal + epigastrium retraction - Restlessness - Inpiration stridor

Jackson Clasification (cont..)

Stadium 3 : - Suprasternal + epigastium + supraclavicula + intercostal retraction - Restlessness and dyspnea - Inspiratory + expiratory stridor

Stadium 4 : - Deep retraction, fatique - Cyanosis asfixia, apnea

Cause :1. Congenital abnormality : - laryngomalacia - congenital web

- stenosis subglotic

Choanal Atresia

2. Foreign body : - FB Rima glotis, subglotis, trachea

3. Infection/Inflamation : - laryngitis, epiglotitis bacterial,diptheria,tb

Cause : (cont..)

Cause : (cont..)

4. Trauma : - Post intubation - Iatrogenic post surgical - Burn trauma inhalation - External blunt or sharp

Cause : (cont..)5. Tumor : - Benign : papilloma, haemangioma - Malignancy : laryngeal carcinoma

Cause : (cont..)

6. Bilateral abductor paralysis of the vocal cord - Complication of thyroid surgery

- Neck trauma blunt, penetrating in juries - Malignancy in neck or mediastinum

- Central nervous system disease - Idiopatic

Diagnostic

- Clinical features- Blood gas analysis (astrup)- Direct laryngoscopy (if posible)- Flexible fibreoptic laryngoscopy- X-ray lateral soft tissue (neck)- Computed tomografi- Magnetic resonance Imaging (MRI)

Management

• Principally effort to achieve normal upper airways passage.• Conservatif Jackson Std 1 - O2 - Steroid < laryng oedem - AB < infection - Antiinflamation drug

Management (cont..)

• Surgical Depend on cause • Upper Airways Obstruction (Jackson Std 2 – 4) Important live saving procedure :

Emergency Management of Upper Airway Obstruction

Live saving procedure : - Intubation - Cricothyrotomy (not recomended in neonatal and

children - Tracheostomy

Cricothyrotomy

• Indication:– Complete upper airway obstruction

unmanageable by intubation in adult patient.– Standard tracheostomy is not possible.– Unstable cervical spine fracture complicated

by airway difficulties where extension of the neck for tracheostomy may cause nerve injury.

• Contra indication: not recommended for children

Advantages

• Extremely rapid control of oxygenation and ventilation.

• Requires minimal technical expertise.

• Possible to be performed in any position (including the sitting position).

• No special instrument was needed (possible to be performed in any place).

Procedure

Tracheostomy / Tracheotomy

Definition:

The procedure to make a temporary opening in the anterior neck into the trachea, which air may pass to the lungs bypassing the upper airway.

Indication

1. Upper airway obstruction caused by:a. Infection: Ludwig’s Angina, retropharyngeal abscess,

diphtheria.

b. Inflammation: acute laryngitis, gas or corrosive inhalation, drug reaction.

c. Trauma: laryngotracheal trauma.

d. Laryngotracheal stenosis.

e. Tumor: oropharynx and larynx.

f. Vocal cord paralysis.

Indication

2. Respiratory insufficiency: a. Eliminates upper respiratory dead space.

b. Decreases the upper airway resistance & CO2 retention.

Indication

3. Prolonged intubation: conversion to tracheostomy are:

a. To manage accumulation secretion.

b. To prevent the complication such as sinusitis, OME (nasal intubations), mucosal & cartilage destruction and laryngeal or subglottic stenosis.

c. To minimized daycare in the ICU.

Indication

4. Ineffective mucous clearance due to: a. Loss of cilia.

b. Fractured ribs, unwillingness to cough because of pain.

c. CNS injury.

d. Coma.

e. Vegetative stage.

Indication

5. Elective surgery with difficulty to intubation.

6. Prevent airway obstruction in the head & neck cancer patient who will undergo radio or chemotherapy.