The Obstructed Airway – What to Do Whilst Waiting for Help

In the case discussed in the previous step, the clinical picture is of a patient with a severely compromised upper airway due to obstruction from oedema, secondary to a neck haematoma. This situation is a clinical emergency as there is a risk of complete airway obstruction.

There are several causes of airway obstruction and in the above presentation, Dr Catriona Ferguson discusses the causes and management of airway compromise and what to do whilst waiting for help to arrive.

The obstructed airway is cause of great anxiety for the patients and a stressful situation for the clinicians looking after them.

The key considerations are:
– Who do you need to help you?
– Where is the safest location to manage this patient?
– What equipment do you need to be available?

Learning points

• Good communication and teamwork are paramount: a clear airway management strategy needs to be made and shared with the wider team.
• In our scenario, draining the haematoma may not improve the patency of the airway, as the airway obstruction is largely secondary to tissue oedema and venous and lymphatic congestion.
• Difficulties in swallowing, even in the absence of audible stridor is a cardinal sign of imminent airway obstruction.

In the “See Also” section, you will find additional material referring to the management of specific causes of airway obstruction:

• Foreign Body – Resuscitation Council (UK) Chocking Guidelines
• Anaphylaxis – Australia and New Zealand Anaesthetic Allergy Group Guidelines
• Angioedema

Have you ever managed a patient with airway obstruction? How was this experience? What helped your patient?

Please remember when discussing patients to keep all identifiable information confidential.