Airway emergencies and anaesthetics.pptx

Airways

1. Airway Emergencies Aidah Isa , ENT Consultant ENT Department Raigmore Hospital Inverness Viking Surgeons 25 th November 2020

2. Goals and Objectives Review common ENT airway emergencies Review assessment and management Be aware of conditions that are at risk of rapid deterioration that may lead to airway loss

3. Sites

4. Airway problems Adult Tonsilitis / Quinsy Bleeding Dental/ Deep Neck Space Infections Malignancy HNSCC Lymphoma Supraglotitis Paediatric Adenotonsillar hypertrophy/ Tonsilitis / Quinsy Glandular fever Airway FB Croup Epiglotitis Bleeding Congenital disorders

5. Common symptoms Hoarseness Dysphagia Odynophagia Dyspnoea Otalgia

6. Assessment P, BP, RR Sats ABG’s Look Listen Examine

7. Assessment - listen Stertor (Darth Vader) Stridor Inspiratory Expiratory Biphasic Wheeze

8. Assessment Mouth Neck Posterior Nasal Space Larynx Bronchoscopy CXR Soft tissue X-ray ( AP & lateral) CT with contrast

9. Red Flag Conditions

10. Supraglotitis / Epiglotitis Severe sore throat and odynophagia +/- dyspnoea, drooling, stridor Short history Can progress rapidly ↑ Temp, WCC, CRP Assess urgently IV access, UE, CRP, FBC, Bld Cultures IV 3 rd generation cephalosporins IV Steroids Nebulised Adrenaline Refer to ENT & Anaesthetist ? Secure airway Less common in children, Hib vaccination, more septic

11. Supraglotitis / Epiglotitis Croup Viral prodrome Child well Stridor Barking cough Site subglottis Epiglotitis Haemophilus Influenzae Hib vaccination Septic Stridor Drooling Site: Supraglottis Management: Secure Airway Do Not examine Do Not obtain bloods Speak urgently to anaesthetist

12. Dental Infections Ludwigs angina Dental abcess Deep neck space infections

13. Management

14. Management Oxygen Heliox (Helium/Oxygen) Nebulised Adrenaline Adrenaline 1:1000 1ml in 4ml Saline Nebulised IV Steroids Prednisolone or Dexamethasone IV Antibiotics Drainage abcess Dental extraction Intubation Orotracheal Awake fibreoptic intubation LMA Surgical Airway Cricothyroidotomy Tracheostomy

15. Management

16. Management Anaesthetist ENT Surgeon Maxillo -facial Surgeon Microbiologist Consultant Colleague

17. Airway problems