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Respiratory Obstruction |
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Respiratory obstruction can be caused by: 1. Mechanical obstruction in the airway 2. Pressure on the airway 3. Bronchospams—such as in acute asthma
Inhaled foreign objects If the patient cannot cough the object out: ¨ Young children should be held upside down to try and retrieve the object ¨ Do not slap the patients’ back— this may cause the object to fall further into the respiratory tract ¨ The Heimlich manoeuvre may clear the airway ¨ A cricothyroid puncture using a wide-bore cannula or similar object if obstruction is above this level ¨ Removal by endoscopy ¨ Swallowed objects most often pass uneventfully with the faeces. Plain radiographs of the abdomen are indicated
Upper airway This stimulates the cough reflex, which may clear the obstruction. To aid coughing bend the patient forward. The Heimlich manoeuvre can be achieved by encircling the patient with your arms from behind, and delivering a forceful sudden squeeze by pulling upwards and backwards. This helps to create an assisted cough, which clears the obstruction.
Lower airway Typically, in a semi-upright patient, the foreign object falls into the right posterior basal lobe. If this should happen inform the patient and arrange to have a chest X-ray taken as soon as possible. If the offending item is in the lungs, removal by a chest physician by fibre-optic bronchoscopy is indicated. As this is inevitably followed by collapse and infection distal to the obstruction. |
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With the combination of delicate instruments and a patient lying on an incline there is always the risk of an inhaled foreign body. Complete respiratory obstruction rapidly leads to cerebral hypoxia. Brain damage and death can ensue after only 3 minutes of hypoxia. |
