AIRWAY OBSTRUCTION

Signs and Symptoms:

Dyspnea, tachypnea, labored respirations, stridor, wheezing, cyanosis, apnea

Assessment:
Acute (sudden onset):
Obstructing tongue
Foreign body
Epiglottitis vs. Croup
Angioneurotic edema (anaphylaxis, laryngeal edema)
Upper airway burn
Direct trauma
Aspiration of vomitus

Management/Nursing Care: based on cause of obstruction:

1. OBSTRUCTING TONGUE:
Pt is probably semi-conscious/unconscious
Turn to side, jaw lift

2. FOREIGN BODY:
Partial obstruction: patient awake/coughing/talking
Complete obstruction: unable to breathe/cough/unconscious
Heimlich maneuver

FBs:
a. can have ingested or aspirated FBs
b. anatomic site 2x more often the GI tract than respiratory
c. common areas of obstruction are:
--esophagus at level of cricoid
--aortic arch
--gastric inlet
d. if FB in respiratory tract, tends to lodge in bronchi more commonly
than in trachea or larynx
e. may be partial or complete
 TREATMENT:
a. if FB in GI tract, will pass
b. bronchoscopy == if below cords
laryngoscopy = if above cords
c. if FB in nose: if you can see it, remove it
(unilateral discharge in child indicates FB rather than polyps)
d. monitor O2 status = cyanosis, gums, LOC, anxiety
e. be prepared with ET/trach equipment
f. be prepared for Heimlich

3. EPIGLOTITIS
a. A bacterial infection (croup: viral)
b. URI < 24 hrs, temp > 39 C
c. Dysphagia, drooling, dyspnea, muffled voice, cough usually absent
Stridor less prominent than in croup, ↑ WBC
d. Direct laryngoscopy by expert: cherry red epiglottis with surrounding edema
e. Intubate as epiglottis notorious for sudden airway obstruction
f. Ampicillin 100 mg/kg IV, humidified O2

4. CROUP:
Child is usually < age 3
URI > 24 hours
Rhinorrhea, low-grade temp, high-bitched "barking" cough with
inspiratory stridor, WBC normal
TX: humidified O2 in "tent"

5. LARGYNGEAL EDEMA:
a. A medical emergency caused by anaphylaxis, acute laryngitis, urticaria—SERIOUS
b. Inflammation of throat or edema after intubation
c. Edema causes narrowing of airway evidenced by stridor, dyspnea, anxiety

d. TREATMENT:
--adrenalin
--steroids
--tracheostomy
--monitor O2
--monitor CV status
--monitor air exchange
--maintenance of airway
--tracheostomy care
6. UPPER AIRWAY BURN:
a. Causes edema
b. Needs tracheostomy
c. Maintain airway until healing well

7. DIRECT TRAUMA:
a. Toxic fumes/smoke
b. Trauma to neck from RTA – victim thrown forward, hits neck
c. Damage to larygeal nerves
d. Dysphagia, cough, hemoptysis, neck deformity, tenderness, bony crepitus

8. ASPIRATION OF VOMITUS:
a. Keep patient on side
b. Suction (must always be available for unconscious pt, post-op, critically ill)
c. Maintain O2

AIRWAY CARE:
PROMOTE ADEQUATE OXYGENATION
PROMOTE RESTORATION OF FREE BREATHING
PREVENTION OF COMPLICATIONS OF HYPOXIA

HYPOXIA/HYPOXEMIA:
CYANOSIS, ↑ ANXIETY, DYSPNEA, ↑ PULSE

MONITOR:
O2 sat, color of gums/nailbeds/lips, LOC q 15-30 min. with VS, auscultate lungs, CXR

NURSING CARES:
a. Administration of O2
b. Proper positioning
c. Medications
d. Preparation of artificial airway equipment
e. Emotional support of patient and family
f. Knowledge of disease process
g. THINKING AHEAD:

NURSING OBSERVATION AND PREPARATION CAN SAVE A LIFE!