Prehospital Academy Lesson 15.2
Respiratory Emergencies: Diseases of the Upper Airway
This lesson focuses on diseases and conditions affecting the upper airway, a critical area for EMTs due to its vital role in breathing and the rapid onset of life-threatening obstruction. A thorough understanding of these pathologies allows for swift recognition, appropriate intervention, and potentially life-saving outcomes.
Upper Airway Overview and Vulnerabilities
The upper airway, extending from the nose and mouth to the larynx, is responsible for warming, humidifying, and filtering air. However, its anatomical structure also makes it particularly susceptible to obstruction. Conditions affecting the upper airway can quickly compromise a patient's ability to ventilate and oxygenate, leading to hypoxia and respiratory arrest.
EMTs must always maintain a high index of suspicion for upper airway compromise, especially in patients presenting with altered mental status, trauma to the head/neck, or signs of respiratory distress.
Common Causes of Upper Airway Obstruction
The most frequent causes of upper airway obstruction include:
Tongue: In unresponsive patients, the tongue can fall back and obstruct the oropharynx. Simple maneuvers like the head-tilt chin-lift or jaw-thrust are often sufficient to relieve this.
Foreign Body Airway Obstruction (FBAO): Food, small objects, or other foreign material can partially or completely block the airway. This requires immediate intervention using back blows, abdominal thrusts (Heimlich maneuver), or chest thrusts.
Secretions/Emesis/Blood: Accumulation of fluids due to injury, illness, or aspiration can occlude the airway. Suctioning is the primary intervention.
Swelling (Edema): Conditions like anaphylaxis, epiglottitis, or direct trauma can cause rapid swelling of upper airway structures, narrowing the passage.
Specific Upper Airway Conditions for EMTs
Anaphylaxis (Allergic Reaction)
A severe, life-threatening systemic allergic reaction. Upper airway manifestations include:
Signs: Stridor, hoarseness, swelling of the face, lips, tongue, or throat.
Management: Prioritize airway management, administer high-flow oxygen, and assist with administration of epinephrine (auto-injector or via medical direction).
Epiglottitis
A bacterial infection causing severe inflammation and swelling of the epiglottis. While less common due to vaccinations, it's a pediatric emergency.
Signs: Sudden onset of high fever, sore throat, drooling, difficulty swallowing, stridor, tripod position. The patient may appear anxious and prefer to sit upright and lean forward.
Management: Minimize disturbance, provide oxygen gently, and arrange for rapid, calm transport to a hospital. Avoid inspecting the airway as this can trigger complete obstruction.
Croup (Laryngotracheobronchitis)
A viral infection of the upper airway, commonly seen in pediatric patients, causing swelling around the vocal cords.
Signs: "Seal-bark" cough, stridor (especially on inspiration), hoarseness, low-grade fever, typically worse at night.
Management: Administer humidified oxygen, keep the patient calm, and provide supportive care. Transport as needed.
Airway Management Interventions
EMTs have several tools and techniques for managing upper airway problems:
Manual Airway Maneuvers: Head-tilt chin-lift and jaw-thrust.
Airway Adjuncts: Oropharyngeal Airway (OPA) and Nasopharyngeal Airway (NPA).
Suctioning: To clear secretions, blood, or emesis.
Foreign Body Airway Obstruction Maneuvers: Abdominal thrusts, chest thrusts, back blows.
Positioning: Positioning the patient to optimize airflow (e.g., recovery position, upright for breathing difficulties).
Critical Thinking Questions
You are treating a 5-year-old child presenting with a "seal-bark" cough and stridor. Based on these symptoms, what is your suspected diagnosis, and what interventions would you perform while minimizing patient agitation?
A patient with severe facial trauma is gurgling and has visible blood in their airway. Describe your immediate airway management priorities and the sequence of interventions you would use.
An unresponsive adult patient has snoring respirations. You perform a head-tilt chin-lift, and the snoring resolves. Explain the anatomical reason why this maneuver was effective.
Distinguish between the signs and management of epiglottitis and croup. Why is direct visualization of the airway contraindicated in suspected epiglottitis?
You respond to a restaurant where a conscious adult is choking and unable to speak. They become unconscious as you are performing abdominal thrusts. What is your next immediate course of action according to current BLS guidelines?