PENATALAKSANAAN

Upper Airway Obstruction

(Obstruksi saluran Nafas Atas)

Upper Airways System

- Nose: hypertrophy concha,polyp

- Nasopharynx
- Oropharynx
- Larynx

Anatomi (tonsil-adenoid)

Anatomy of Normal Larynx

Upper Airways Obstruction :

Laryngeal obstruction, one of emergency
condition in ENT field

Hypoxia
Apnea

Death

Clinical
Features
-

Stridor
Airway obstruction, partial or severe
Repeated aspiration
Cyanotic or apnoeic attacks
Husky, weak or absent cry in infants
Husky voice in older children and adult
Atypical pneumonia or bronchitis
Inhaled or ingested foreign body

Jackson Clasification 4
stadium
Stadium 1 :
- Mild suprasternal retraction in inspiration
- Inspiration stridor
Stadium 2 :
- Deep suprasternal + epigastrium retraction
- Restlessness
- Inpiration stridor

Jackson Clasification (cont..)

Stadium 3 :
- Suprasternal + epigastium + supraclavicula
+ intercostal retraction
- Restlessness and dyspnea
- Inspiratory + expiratory stridor
Stadium 4 :
- Deep retraction, fatique
- Cyanosis asfixia, apnea

Cause :
1. Congenital abnormality :
- laryngomalacia
- congenital web
- stenosis subglotic

Choanal Atresia

Cause : (cont..)

2. Foreign body :
- FB Rima glotis, subglotis, trachea
3. Infection/Inflamation :
- laryngitis, epiglotitis bacterial,diptheria,tb

Cause : (cont..)
4. Trauma :
- Post intubation
- Iatrogenic post surgical
- Burn trauma inhalation
- External blunt or sharp

Cause : (cont..)
5. Tumor :
- Benign : papilloma, haemangioma
- Malignancy : laryngeal carcinoma

Cause : (cont..)
6. Bilateral abductor paralysis of the vocal
cord
- Complication of thyroid surgery
- Neck trauma blunt, penetrating in
juries
- Malignancy in neck or mediastinum
- Central nervous system disease
- Idiopatic

Diagnostic
-

Clinical features
Blood gas analysis (astrup)
Direct laryngoscopy (if posible)
Flexible fibreoptic laryngoscopy
- X-ray lateral soft tissue (neck)
- Computed tomografi
- Magnetic resonance Imaging (MRI)

Management
Principally
effort to achieve normal upper airways
passage.
Conservatif Jackson Std 1
- O2
- Steroid < laryng oedem
- AB < infection
- Antiinflamation drug

Management (cont..)
Surgical
Depend on cause
Upper Airways Obstruction
(Jackson Std 2 4)
Important live saving procedure :

Emergency Management of Upper

Airway Obstruction

Live saving procedure :

- Intubation
- Cricothyrotomy (not recomended in
neonatal and children
- Tracheostomy

Cricothyrotomy
Indication:
Complete upper airway obstruction
unmanageable by intubation in adult patient.
Standard tracheostomy is not possible.
Unstable cervical spine fracture complicated by
airway difficulties where extension of the neck
for tracheostomy may cause nerve injury.

Contra indication: not recommended for

children

Advantages
Extremely rapid control of oxygenation and
ventilation.
Requires minimal technical expertise.
Possible to be performed in any position
(including the sitting position).
No special instrument was needed (possible
to be performed in any place).

Procedure

Tracheostomy / Tracheotomy
Definition:
The procedure to make a
temporary opening in the
anterior neck into the trachea,
which air may pass to the
lungs bypassing the upper
airway.

Indication
1. Upper airway obstruction caused by:
a. Infection: Ludwigs Angina, retropharyngeal abscess,
diphtheria.
b. Inflammation: acute laryngitis, gas or corrosive
inhalation, drug reaction.
c. Trauma: laryngotracheal trauma.
d. Laryngotracheal stenosis.
e. Tumor: oropharynx and larynx.
f. Vocal cord paralysis.

Indication
2. Respiratory insufficiency:
a. Eliminates upper respiratory dead space.
b. Decreases the upper airway resistance &
CO2 retention.

Indication
3. Prolonged intubation: conversion to
tracheostomy are:
a. To manage accumulation secretion.
b. To prevent the complication such as sinusitis,
OME (nasal intubations), mucosal & cartilage
destruction and laryngeal or subglottic stenosis.
c. To minimized daycare in the ICU.

Indication
4. Ineffective mucous clearance due to:
a. Loss of cilia.
b. Fractured ribs, unwillingness to cough
because of pain.
c. CNS injury.
d. Coma.
e. Vegetative stage.

Indication
5. Elective surgery with difficulty to
intubation.
6. Prevent airway obstruction in the head &
neck cancer patient who will undergo
radio or chemotherapy.