Airway Obstruction

Airway obstruction: Partial or complete blockage of the breathing tubes to the lungs. Obstruction of the airway can be due to different causes including foreign bodies, allergic reactions, infections, anatomical abnormalities and trauma. The onset of respiratory distress may be sudden with cough. There is often agitation in the early stage of airway obstruction. The signs of respiratory distress include labored, ineffective breathing until the person is not longer breathing (apneic). Loss of consciousness occurs if the obstruction is not relieved. Treatment of airway obstruction due to a foreign body includes: * Adults: The Heimlich maneuver. * Children over 1 year of age: A series of 5 abdominal thrusts (a children's version of the Heimlich maneuver * Infants under 1 year of age: A combination of 5 back blows (with the flat of the hand) and 5 abdominal thrusts (with 2 fingers on the upper abdomen). Diagnosis Obstruction can be measured using spirometry. A decreased FEV1/FVC ratio (versus the normal of about 80%) is indicative of an airway obstruction, as the normal amount of air can no longer be exhaled in the first second of expiration. An airway restriction would not produce a reduced FEV1/FVC ratio, would produce a reduced vital capacity. The ventilation is therefore affected leading to a ventilation perfusion mismatch and hypoxia. Airway obstruction * The majority of preventable deaths following trauma occur as a result of airway obstruction. * Obstruction may occur at any point within the airway, from the upper airways to the bronchi deep within the chest. Common causes of airway obstruction Upper Airway * tongue (due to unconsciousness) * soft tissue swelling * blood, vomit * direct injury

Larynx (voice box) * foreign material, direct injury, soft tissue swelling Lower Airway * secretions, oedema, blood * bronchospasm * aspiration of gastric contents Recognition of airway obstruction * LOOK for chest/abdominal movement * LISTEN at mouth and nose for breath sounds and abnormal noises * FEEL at mouth and nose for expired air Abnormal sounds in airway obstruction * Snoring - due to obstruction of upper airway by the tongue * Gurgling - due to obstruction of upper airway by liquids (blood, vomit) * Wheezing - due to narrowing of the lower airways Complete airway obstruction is silent. Opening the airway * Remove crash helmet with manual in-line stabilisation of the c-spine * Head tilt (NOT if c-spine injury) * Chin lift with manual in-line stabilisation of the c-spine * Jaw thrust with manual in-line stabilisation of the c-spine * Suction with manual in-line stabilisation of the c-spine

Oral airways * Will stimulate vomiting and movement in conscious or semi-conscious casualties * This may result in; worsening airway problems cervical spine compromise Sizing an oropharyngeal airway

Oropharyngeal airway insertion

Nasal airways

* Will cause bleeding from the nose in a large number of cases. * This will result in worsening airway problems so use only as a last resort.