upper airways obstruction kppik a

- Nose- Nasopharyng- Oropharyng- Laryng

Upper Airways System

KPPIK FKUI 20-23 Maret 2008

Upper Airways Obstruction : Laryngeal obstruction, one of emergency

condition in ENT field


hypoxia apnea death

Clinical Features

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

epigastrium- Fatique, restlessness, cyanosis indicative of hypoxia


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


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)- Laryngoscopy (if posible)- 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 :

- Endotracheal intubation- Cricothyrotomi- Tracheostomi


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


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.


Procedure

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

or metal.• Surgical technique: adult or

children, elective or emergency.

• Postoperative care: temporary, prolonged or permanent.


Incision


Air Aspiration Test


Trachea Incision


Tube InsertionGauze Dressing


upper airways obstruction kppik a

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