Learn how to recognize and identify proper management of partial and/or complete upper airway obstruction, laryngospasm, and apnea, and when a patient requires a higher level of airway intervention.
Partial Upper Airway Obstruction
- Definition: Compromised airflow through the pharynx
- Common causes: Tonsillar hypertrophy, excess pharyngeal soft tissue, enlarged tongue/epiglottis, relatively large head/positioning, medication affect on airway tone
- Signs/symptoms: Stertor, retractions, hypoxemia, hypercapnia
- Interventions: supplemental oxygen, reposition, continuous positive airway pressure, chin lift, jaw thrust, consider adjunct airway (nasal or oral)
Complete Upper Airway Obstruction
- Definition: Absent airflow through the upper airway/pharynx
- Common causes: Tonsillar hypertrophy, excess pharyngeal soft tissue, enlarged tongue/epiglottis, relatively large head/positioning, medication affect on airway tone
- Signs/symptoms: Absent upper airway flow despite increased respiratory effort, retractions, hypoxemia, hypercapnia
- Interventions: Call for help, supplemental oxygen, reposition, continuous positive airway pressure, chin lift, jaw thrust, consider adjunct airway (nasal or oral)
Laryngospasm
- Definition: Compromised airflow through the larynx as a result of vocal cord spasm. May be complete or incomplete.
- Common causes: Sedative medication effects, inflammation/irritation to vocal cords (illness, persistent crying), instrumentation of posterior pharynx, stimulation during period sedation transition (induction/recovery)
- Signs/symptoms: Stridor Paradoxical chest/abdominal movement, hypoxemia
- Interventions: Call for help, supplemental oxygen, continuous positive airway pressure, sedation deepening, pressure to laryngeal notch, consider muscle relaxant/intubation
Apnea
- Definition: Cessation of breathing for >20 seconds
- Common causes: Central nervous system medication effect
- Signs/symptoms: Cessation of airflow and respiratory effort, loss of waveform on capnography, oxygen desaturation
- Interventions: Bag-mask ventilation with 100% oxygen, consider pausing/discontinuing medication with respiratory depressive effects