In this section, Dr Catriona Ferguson, Consultant Anaesthetist at University College London Hospitals, Royal National Throat, Nose and Ear Hospital will guide us through the recognition and management of airway obstruction.
First, let’s start by looking at this clinical scenario:
A young, otherwise fit and well patient had elective surgery to remove a benign submandibular tumour with a left neck dissection. The surgery was uneventful and the surgeon was happy with the haemostasis. Only 50mls of blood drained overnight, so the drain was removed the following day and the patient was discharged. In the evening her neck started to swell and she developed tenderness in her neck, difficulties in swallowing and changes in her voice, so she attended her local Accident and Emergency department.
On arrival these were the observations:
- Respiratory rate: 22 breaths per minute
- Oxygen saturation: 95% on 6l/O2/min
- Heart rate: 105 bpm
- Blood pressure: 158/81
On examination, she was distressed and sitting upright with her left neck significantly swollen, extending to above the cricoid region and across the midline. Mouth opening and neck movement were limited and there was sublingual swelling which had lifted the tongue to roof of the mouth. Her trachea was palpable but deviated to the right.
A nasal endoscopy showed significant supraglottic oedema, involving the epiglottis, and the vocal cords could not be visualised.
Are you concerned? How would you manage this patient? What next steps should be taken?
Please share your thoughts in the discussion here below.