Narciso A. Cañiban

Laryngeal

Obstruction

ANAPHYSIO

Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. Because choking cuts off oxygen to the brain, administer first aid as quickly as possible. Without FIRST AID, the lack of airflow can cause serious brain damage or even death by asphyxiation

Causes:

Foreign objects such as:Fish bonesLarge pieces of meatCoinsPeanutsPins Small toysButtons

AnaphylaxisLaryngeal EdemaTraumaLaryngeal TumorsLaryngospasmsTongue falling backThick secretions

Interventions

Assess the cause of obstruction!

Tongue falling backChin lift, Jaw thrust Maneuvers

Head-chin tilt

Jaw thrust

Insert an oropharyngeal airway

• Select a proper sized airway. This is done by placing the airway against the patient´s face. A correctly sized airway will extend from the patient´s mouth to the angle of the jaw.

• Open the patient´s mouth with the chin lift maneuver. • Insert the oral airway upside down, so its concavity is

directly upward, until the soft palate is reached. At this point the airway is rotated 180 degrees, the concavity is directed inferiorly and the airway is slipped into place over the tongue. In children it is better to depress the tongue with a spatula before inserting the airway in the correct position. The airway must not push the tongue backward and therefore block the airway.

• If cause is edema due to anaphylaxis:

• Administration of subcutaneous epinephrine or corticosteroid

• If laryngospasms…

• Hyperextending the patient's neck and administering assisted ventilation with 100% oxygen. In more severe cases it may require the administration of an intravenous muscle relaxant such as Succinylcholine .

If the cause is foreign body aspiration…

Make sure the person is choking ! It is important to be able to

distinguish between partial and total airway obstruction. If a person is not truly choking, and has partial airway obstruction, you are better off letting him COUGH to remove the obstruction himself .

Someone who is truly choking (total airway obstruction) will display one or more of the following signs

Universal sign for choking (hands clutched to the throat)

• Being unable to talk• The person cannot breathe effectively,

there will be no air movement• Cannot cough effectively• Noisy breathing• Changes in skin color: blue lips and

fingernails• Eventual unconsciousness.

• Signs that the obstruction is partial rather than total :

• Able to speak, cry, respond to you• Breathing is noisy, labored, or gasping,

some air will come from the mouth• Coughing, or making "crowing" noises• Very agitated or anxious• Skin goes paler, blue color.

• Ask the person, "Are you choking?

If the person responds: • Reassure the person.• Encourage the person to cough. Do not

use back blows.• Keep monitoring the situation.• Call an ambulance if the obstruction is

not relieved, or you can hear wheezing or noisy breathing.

• If the person cannot respond, shout for help.

If there is someone nearby, tell him to call for emergency services.

• If the person is conscious, communicate your intent to perform first aid.

It's best to make sure that someone who is conscious know what you plan to do; this will also give him an opportunity let you know if your assistance is welcomed.

If choking is occurring, the Red Cross recommends a "five-and-five" approach to delivering first aid.

• Administer up to 5 back blows using the heel of your hand.

• Take the bottom part (heel) of your hand and deliver 5 separate forceful strikes between the person's shoulder blades.

• Keep the back blows separate. Try to dislodge the object with each one.

• Look for improvement after each one.

If the back blows fail, perform 5 abdominal thrusts (aka, the Heimlich Maneuver)

• Get behind the victim.• Wrap your arms around his waist.• Take the underside of one fist and place it near

the middle of the person's abdomen, with the thumb-side against the abdomen, just above the navel and below the breastbone.

• Grasp that fist in your other hand.• Give up to 5 separate, inward and upward

thrusts. Continue until the obstruction is dislodged - check after each thrust. Stop if the victim becomes unconscious.

• If the obstruction has not been relieved, alternate between 5 back blows and 5 abdominal thrusts until the object becomes unstuck.

• Make sure the object is completely gone.

• If the person is able, look for him to spit it out and breathe without difficulty.

• Perform a finger sweep on an unconscious or incapacitated person to remove the object from his mouth. Grasp the person's tongue and lower jaw and lift to open his mouth. Sweep the object out.

Check to see if normal breathing has returned.

Self-administration

• Try to cough out the foreign object. If you can still cough forcefully, you

do not need to perform the Heimlich Maneuver. However, if you are truly struggling for air, you need to act quickly; you need to expel the obstruction.

• Find something about waist high that you can bend over.

• Make a fist. Place it on your abdomen just above your navel. This fist placement is the same as in the traditional Heimlich Maneuver.

• Hold that fist with your other hand.

• Bend over the chair, table, counter or other solid object. Brace your fists between the chair and your abdomen.

• Drive your fist in and up. Use a quick j-shaped motion – in and then up. Drive your body against the solid object; this will greatly increase the force you can apply.

• Repeat until the object is removed.

• If treating a pregnant women or an obese person, you should modify your Heimlich maneuver technique as follows:– Place your hands higher than described above.

The correct position is with the hands on the breast bone just above where the lowest ribs

– Press hard into the chest with quick thrusts as described above. However, you will not be able to make the same upward thrusts.

• Choking will likely occur quickly if it is as the result of a swallowed object or item of food; choking caused by internal swelling is usually more gradual.

Endotracheal Intubation

• Endotracheal intubation is the placement of a tube into the trachea (windpipe) in order to maintain an open airway in patients who are unconscious or unable to breathe on their own. Oxygen, anesthetics, or other gaseous medications can be delivered through the tube.

•

Surgical Management

• CRICOTHROIDOTOMY

• Cricothyroidotomy is an emergency procedure that is performed when the patient's airway is blocked, and less invasive attempts to clear it have failed. Cricothyroidotomy creates a surgical airway by making an incision in the cricothyroid membrane, then inserting a tracheostomy tube through the incision and into the trachea.

• Use your index finger to identify the cricothyroid membrane, the soft indentation just below the Adam's apple.

• Stabilizing the trachea with thumb and forefinger, make a transverse incision through the skin, over the membrane.

• Push the scalpel straight down through the cricothyroid membrane. You will feel a "pop" as you pass into the trachea.

• Place a tube or tube-like device into the trachea to keep the airway open.

• Tape the airway in place.

An emergency cricothyroidotomy can be left in place for up to 72 hours, but after that, it should be replaced by a tracheostomy, placed lower in the trachea by trained surgeons.

TRACHEOSTOMY

• A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube.

• An emergency tracheostomy is reserved for the client who cannot be intubated with an endotracheal tube.

• Can establish airway in less than two minutes.

• Can be done in local or general anesthesia