Common symptoms of Acute airway obstruction Voice change
Common symptoms of Acute airway obstruction ØVoice change ØDyspnea ØLocal pain ØCough
Common findings of Acute airway obstruction v Stridor v Hoarseness v Retraction (intercostal, suprasternal, supraclavicular) v Drooling v Bleeding v emphysema
Causes of Upper airway obstruction q Trauma q Inflammatory diseases q Benign neoplasms q Malignant neoplasms q Others
Laryngeal Trauma
Ø External laryngeal injury o blunt neck trauma o penetrating wound Ø Internal laryngeal injury o prolonged endotracheal intubation o post trachestomy o post surgical procedures o post irradiation o endotracheal burn (thermal – chemical)
Inflammatory diseases CROUP AND EPIGLOTTITIS
Croup Symptoms Barking Cough Hoarse Voice Inspiratory Stridor Varying Degrees of Respiratory Distress Ages infancy [1 -3] (peak 2 years)
Epiglottitis v Inflammation of epiglottis from bacteria § Haemophilus influenza § Streptococcus pneumonia § Streptococcus pytogen (Tan, Chan & Cheng, 2007)
Epiglottitis Sign and Symptoms q High Fever q Dysphagia q Stridor q Epiglottis swelling q X-ray Lateral soft tissue: “thumbprint”sign (Tan, Chan & Cheng, 2007)
Epiglottitis q A potentially life-threatening form of upper airway obstruction characterized by: q High fever q Sore throat q Dyspnea q Rapidly progressive respiratory obstruction q Inspiratory stridor q required emergent endotracheal intubation (Tan, Chan & Cheng, 2007)
Epiglottitis Physical Findings: Left picture: nearly completely blocked airway Right picture: airway opened after intubation
Epiglottitis Treatment Ø Maintain airway !!!! Ø Empiric antibiotics to cover most likely organisms (Ceftriaxone, cefuroxime, ampicillin plus chloramphenicol) Ø + or - Steroids (dexamethasone) Ø Tracheostomy (Tan, Chan & Cheng, 2007)
Vocal cord paralysis
Unilateral vocal fold paralysis q Hoarseness/Weak voice q Coughing q Difficult swallowing q Choking q. Management : ü Voice therapy ü Injection laryngoplasty - Autologous fat, Gelfoam ü Medialization thyroplasty ü Arytenoid adduction ü Laryngeal Reinnervation
Bilateral Vocal Cord Paralysis q The significant problem is airway obstruction q Dyspnea and stridor q. The patient's voice quality is usually only mildly q Management: 1) tracheostomy 2) vocal cord lateralization: arytenoidectomy, and cordectomy 3) reinnervation (�������� )
Tracheostomy
Indications for tracheostomy v Upper Air way obstruction q Bilateral vocal cord paralysis q Obstructive sleep apnea q Major head & neck surgery or trauma v Clear airway and secretion q Manage bronchopulmonary secretion v Prolonged intubation q Ventilation support q Inability to intubate v Prevent aspiration
Advantages of tracheostomy lower risk of laryngotracheal injury improved comfort/mobility improve airway stabilization allows for oral nutrition improved secretion clearance
Tracheostomy tube Koken tube Regular tube Low Presser cuff Standard tube
Tracheal incision
Tracheal incision
Immediate complications Hemorrhage Apnea (chronic obstructive) Recurrent laryngeal n. injury False route Electrocautery fire Injury to adjacent structures
Intermediate complications Hemorrhage [most common] Infection Subcutaneous emphysema Pneumomediastinum/ Pneumothorax Obstruction of tracheostomy tube Displacement of tube Atelectasis Tracheoesophageal fistula
Late complications Hemorrhage Tracheal/ subglottic stenosis Tracheocutaneous fistula Difficult decanulation
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