0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

SYMPTOMS/EXAM

■ Depends on the nature and location of the obstruction

■ Stridor

■ Inspiratory = supraglottic/glottic/larynx

■ Expiratory = subglottic

■ Wheezing or poor air exchange

■ Voice change

■ Dysphagia

■ Coughing episodes

■ Respiratory accessory muscle use

■ Respiratory compromise and cardiopulmonary arrest

DIAGNOSIS

■ Visualization may be possible using direct laryngoscopy or indirect laryn-

goscopy (placing a mirror into the posterior oropharynx).

■ CXR inspiratory/expiratory views might show hyperinflation distal to

obstruction (air trapping and asymmetry) in acute episodes.

■ X-ray or CT of soft tissues of the neck will usually identify radiopaque for-

eign bodies.

TREATMENT

■ For complete obstruction

■ Adults: Heimlich, finger sweep, Magill forceps/laryngoscopy, cricothy-

rotomy, or tracheostomy

■ Children: Back blows, then chest thrusts; avoid blind finger sweep,

transtracheal jet ventilation until definitive airway is obtained

■ If unable to remove, consider pushing FB into one bronchus and venti-

lating the other lung until consultant arrives.

■ For incomplete obstruction

■ Do not do anything that could turn it into a complete obstruction.

■ Preferably remove under direct visualization; consultation for endoscopy

may be necessary

INFECTIONS/INFLAMMATION

Epiglottitis

ETIOLOGY

■ H. influenzatype B: Classic since HIB vaccine more common in adults

than children

■ May also see S. pneumonia,B. catarrhalis

■ Noninfectious causes include fumes, gasoline ingestion, angioedema, and

super-heated steam.

SYMPTOMS/EXAM

■ Dysphagia

■ Rarely hoarse

■ Varied presentations, but more severe in children

■ Classic case is rapid onset, fever, drooling, tripod position.

■ Pain with tracheal rock (moving the thyroid cartilage)

The classic PA X-ray shows a

round coin in the neck. This

coin is in the esophagus,

which is far more common

and far less scary than a coin

in the trachea.

Always have the difficult

airway cart (including

cricothyrotomy equipment) at

bedside for a potentially

difficult airway.