Respiratory obstruction / Airway Obstruction

Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Respiratory obstruction / Airway Obstruction, and its management. Highly recommended for II B.Sc Nursing Students.

1. RESPIRATORY OBSTRUCTION

2. Airway obstruction is a blockage of respiration in the airway. It can be broadly classified into being either in the upper airway or lower airway. DEFINITION

3. Upper airway obstruction Causes of upper airway obstruction include foreign body aspiration, blunt laryngotracheal trauma, penetrating laryngotracheal trauma, tonsillar hypertrophy, paralysis of the vocal cord or vocal fold, acute laryngotracheitis such as viral croup, bacterial tracheitis , epiglottitis, peritonsillar abscess, pertussis, retropharyngeal abscess, spasmodic croup. In basic and advanced life support airway obstructions are often referred to as A-problems. Management of airways relies on both minimal- invasive and invasive techniques.

4. Lower airway obstruction Lower airway obstruction is mainly caused by increased resistance in the bronchioles (usually from a decreased radius of the bronchioles) that reduces the amount of air inhaled in each breath and the oxygen that reaches the pulmonary arteries. It is different from airway restriction (which prevents air from diffusing into the pulmonary arteries because of some kind of blockage in the lungs). Diseases that cause lower airway obstruction are termed  obstructive lung diseases. Lower airway obstruction can be measured using   spirometry . A decreased FEV1/FVC ratio (versus the normal of about 80 %) is indicative of an airway obstruction, as the normal amount of air can no longer be exhaled in the first second of expiration. The ventilation is therefore affected leading to a ventilation perfusion mismatch and hypoxia.

5. Upper airway obstructions occur in the area from nose and lips to larynx (voice box). Lower airway obstructions occur between larynx and the narrow passageways of lungs . Partial airway obstructions allow some air to pass. But can still breathe with a partial airway obstruction, but it’s difficult . Complete airway obstructions don’t allow any air to pass. Pt can’t breathe if they have a complete airway obstruction Acute airway obstructions are blockages that occur quickly. Choking on a foreign object is an example of an acute airway obstruction. Chronic airway obstructions occur two ways: by blockages that take a long time to develop or by blockages that last for a long time.

6. inhaling or swallowing a foreign object small object lodged in the nose or mouth allergic reaction trauma to the airway from an accident vocal cord problems breathing in a large amount of smoke from a fire viral infections bacterial infections chronic obstructive pulmonary disease (COPD ) cystic fibrosis respiratory illness that causes upper airway inflammation (croup) swelling of the tongue or epiglottis abscesses in the throat or tonsils collapse of the tracheal wall ( tracheomalacia ) asthma chronic bronchitis emphysema CAUSES

7. agitation cyanosis (bluish-colored skin) confusion difficulty breathing gasping for air panic high-pitched breathing noises such as wheezing unconsciousness SYMPTOMS

8. alterations in normal breathing pattern, whether rapid or shallow breathing decreased breath sounds in lungs high-pitched breath sounds in the upper airway or mouth no breathing bluish skin color unconsciousness DIAGNOSIS

9. The Heimlich maneuver This is an emergency technique that may help a person who is choking on a foreign object: The maneuver involves one person standing behind the person who is choking, wrapping their arms around the choking person’s waist. The person performing the maneuver then makes a fist with one hand and puts it slightly above the person’s belly button. They should then grab that fist with their other hand and press into the person’s abdomen with five quick thrusts. They should repeat these five abdominal thrusts until the object becomes dislodged or emergency services arrive.

10. Epinephrine Epinephrine can be used to treat airway swelling due to an allergic reaction. Cardiopulmonary resuscitation (CPR) CPR is used when a person is unable to breathe and has lost consciousness. It keeps oxygenated blood flowing to the brain until emergency services arrive. An endotracheal or nasotracheal tube may be inserted into the airway. This can help get oxygen through swollen airways. A tracheostomy and cricothyrotomy are surgical openings made in the airway to bypass an obstruction.

11. PREVENTION Avoid drinking a lot of alcohol before eating. Eat small bites of food. Eat slowly. Chew thoroughly before swallowing. Make sure dentures fit properly. Don’t smoke. Visit ydoctor regularly if they have a condition that can cause a chronic airway obstruction.

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