Upper Airways System

- Nose

- Nasopharyng
- Oropharyng
- Laryng

KPPIK FKUI 20-23 Maret 2008

KPPIK FKUI 20-23 Maret 2008

Upper Airways Obstruction :

Laryngeal obstruction, one of emergency
condition in ENT field

hypoxia
apnea
death
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Clinical
Features

Dysphonia afonia
Barking cough
Inspiratory stridor
Retraction in inspiration
suprasternal, supraclavicula, intercostal ,
epigastrium
- Fatique, restlessness, cyanosis
indicative of hypoxia
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Jackson Clasification 4
stadium
Stadium 1 :
- Mild suprasternal retraction in inspiration
- Inspiration stridor
Stadium 2 :
- Deep suprasternal + epigastrium retraction
- Restlessness
- Inpiration stridor

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Jackson Clasification (cont..)

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

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

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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

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Diagnostic
-

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

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

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

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Emergency Management
of Upper Airway
Live
saving procedure :
Obstruction
- Intubation
- Cricothyrotomy
- 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

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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).

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Procedure

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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.

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Procedure
Informed consent.
Instruments.
Tracheostomy tube:
porstex or metal.
Surgical technique: adult
or children, elective or
emergency.
Postoperative care:
temporary, prolonged or
permanent.

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Incision

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Incision

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Air Aspiration Test

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Trachea Incision

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Tube InsertionGauze
Dressing

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KPPIK FKUI 20-23 Maret 2008