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.