33. Clinical signs of obstructions of the upper airways (upper airway stenosis), coniotomy, tracheotomy
Upper airway obstruction
- Etiology
- Tumor
- Inflammation
- Infections
- Croup
- Epiglottitis
- Tracheitis
- Peritonsillar abscess
- Retropharyngeal abscess
- Oedema
- Anaphylaxis
- Angioedema
- Trauma
- Foreign body
- Clinical features
- Dyspnoea
- Stridor
- Inspiratory if larynx or above
- Expiratory if trachea or below
- Respiratory distress
- Coughing
- Haemoptysis
- Cyanosis
- Treatment
- Airway protection with intubation, cricothyrotomy, or tracheotomy
- Cricothyrotomy, also called coniotomy
- In case of upper airway obstruction with unsuccessful intubation
- Airway is opened through cricothyroid ligament between the thyroid and cricoid cartilage
- Should be converted to tracheotomy when possible
- Indications
- Angioedema
- Foreign body in upper airway
- Severe facial trauma
- Procedure
- Transverse surgical incision into skin between thyroid and cricoid cartilages
- Incision through skin, spf cervical fascia, deep cervical fascia, pre-tracheal fascia, median cricothyroid ligament
- Insertion of catheter
- Tracheotomy is a permanent or temporary stoma between cricoid cartilage and sternal notch
- Indication
- Long-term mechanical ventilation
- Obstruction outside larynx or trachea
- Struma
- Cervical or mediastinal tumor
- Obstruction in the wall of larynx or trachea
- Laryngeal oedema
- Foreign body
- Prophylactic
- Procedure
- Vertical skin incision between cricoid cartilage and sternal notch
- Separation of pre-laryngeal muscles
- Cut thyroid isthmus
- Insertion and fixation of tracheostomy tube
- X-ray to confirm placement