upper airways obstruction kppik a

- Nose- Nasopharyng- Oropharyng- Laryng

Upper Airways System

KPPIK FKUI 20-23 Maret 2008

KPPIK FKUI 20-23 Maret 2008

Upper Airways Obstruction : Laryngeal obstruction, one of emergency

condition in ENT field

KPPIK FKUI 20-23 Maret 2008

hypoxia apnea death

Clinical Features

- Dysphonia afonia- Barking cough- Inspiratory stridor- Retraction in inspiration suprasternal, supraclavicula, intercostal ,

epigastrium- Fatique, restlessness, cyanosis indicative of hypoxia

KPPIK FKUI 20-23 Maret 2008

Jackson Clasification 4 stadium

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

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

KPPIK FKUI 20-23 Maret 2008

Jackson Clasification (cont..)

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

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

KPPIK FKUI 20-23 Maret 2008

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

KPPIK FKUI 20-23 Maret 2008

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

KPPIK FKUI 20-23 Maret 2008

Diagnostic

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

KPPIK FKUI 20-23 Maret 2008

Management

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

KPPIK FKUI 20-23 Maret 2008

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

- Endotracheal intubation- Cricothyrotomi- Tracheostomi

KPPIK FKUI 20-23 Maret 2008

Emergency Management of Upper Airway ObstructionLive saving procedure : - Intubation - Cricothyrotomy - 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

KPPIK FKUI 20-23 Maret 2008

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).

KPPIK FKUI 20-23 Maret 2008

Procedure

KPPIK FKUI 20-23 Maret 2008

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.

KPPIK FKUI 20-23 Maret 2008

Procedure

• Informed consent.• Instruments.• Tracheostomy tube: porstex

or metal.• Surgical technique: adult or

children, elective or emergency.

• Postoperative care: temporary, prolonged or permanent.

KPPIK FKUI 20-23 Maret 2008

Incision

KPPIK FKUI 20-23 Maret 2008

Incision

KPPIK FKUI 20-23 Maret 2008

Air Aspiration Test

KPPIK FKUI 20-23 Maret 2008

Trachea Incision

KPPIK FKUI 20-23 Maret 2008

Tube InsertionGauze Dressing

KPPIK FKUI 20-23 Maret 2008

KPPIK FKUI 20-23 Maret 2008