upper airways obstruction kppik a
DESCRIPTION
Upper Airways Obstruction KPPIK ATRANSCRIPT
- Nose- Nasopharyng- Oropharyng- Laryng
Upper Airways System
KPPIK FKUI 20-23 Maret 2008
KPPIK FKUI 20-23 Maret 2008
Upper Airways Obstruction : Laryngeal obstruction, one of emergency
condition in ENT field
KPPIK FKUI 20-23 Maret 2008
hypoxia apnea death
Clinical Features
- Dysphonia afonia- Barking cough- Inspiratory stridor- Retraction in inspiration suprasternal, supraclavicula, intercostal ,
epigastrium- Fatique, restlessness, cyanosis indicative of hypoxia
KPPIK FKUI 20-23 Maret 2008
Jackson Clasification 4 stadium
Stadium 1 : - Mild suprasternal retraction in inspiration - Inspiration stridor
Stadium 2 : - Deep suprasternal + epigastrium retraction - Restlessness - Inpiration stridor
KPPIK FKUI 20-23 Maret 2008
Jackson Clasification (cont..)
Stadium 3 : - Suprasternal + epigastium + supraclavicula + intercostal retraction - Restlessness and dyspnea - Inspiratory + expiratory stridor
Stadium 4 : - Deep retraction, fatique - Cyanosis asfixia, apnea
KPPIK FKUI 20-23 Maret 2008
Cause :1. Congenital abnormality : - laryngomalacia - congenital web
KPPIK FKUI 20-23 Maret 2008
2. Foreign body : - FB Rima glotis, subglotis, trachea
3. Infection/Inflamation : - laryngitis, epiglotitis bacterial,diptheria,tb
Cause : (cont..)
Cause : (cont..)4. Trauma : - Post intubation - Iatrogenic post surgical - Burn trauma inhalation - External blunt or sharp
Cause : (cont..)5. Tumor : - Benign : papilloma, haemangioma - Malignancy : laryngeal carcinoma
Cause : (cont..)
6. Bilateral abductor paralysis of the vocal cord - Complication of thyroid surgery - Neck trauma blunt, penetrating in juries - Malignancy in neck or mediastinum - Central nervous system disease - Idiopatic
KPPIK FKUI 20-23 Maret 2008
Diagnostic
- Clinical features- Blood gas analysis (astrup)- Laryngoscopy (if posible)- X-ray lateral soft tissue (neck)- Computed tomografi- Magnetic resonance Imaging (MRI)
KPPIK FKUI 20-23 Maret 2008
Management
• Principally effort to achieve normal upper airways passage.• Conservatif Jackson Std 1 - O2 - Steroid < laryng oedem - AB < infection - Antiinflamation drug
KPPIK FKUI 20-23 Maret 2008
Management (cont..)• Surgical Depend on cause • Upper Airways Obstruction (Jackson Std 2 – 4) Important live saving procedure :
- Endotracheal intubation- Cricothyrotomi- Tracheostomi
KPPIK FKUI 20-23 Maret 2008
Emergency Management of Upper Airway ObstructionLive saving procedure : - Intubation - Cricothyrotomy - Tracheostomy
Cricothyrotomy
Indication :– Complete upper airway obstruction unmanageable
by intubation in adult patient.– Standard tracheostomy is not possible.– Unstable cervical spine fracture complicated by
airway difficulties where extension of the neck for tracheostomy may cause nerve injury.
Contra indication : not recommended for children
KPPIK FKUI 20-23 Maret 2008
Advantages
• Extremely rapid control of oxygenation and ventilation.
• Requires minimal technical expertise.• Possible to be performed in any position
(including the sitting position).• No special instrument was needed (possible to be
performed in any place).
KPPIK FKUI 20-23 Maret 2008
Procedure
KPPIK FKUI 20-23 Maret 2008
Tracheostomy / Tracheotomy
Definition:The procedure to make a temporary opening in the anterior neck into the trachea, which air may pass to the lungs bypassing the upper airway.
KPPIK FKUI 20-23 Maret 2008
Procedure
• Informed consent.• Instruments.• Tracheostomy tube: porstex
or metal.• Surgical technique: adult or
children, elective or emergency.
• Postoperative care: temporary, prolonged or permanent.
KPPIK FKUI 20-23 Maret 2008
Incision
KPPIK FKUI 20-23 Maret 2008
Incision
KPPIK FKUI 20-23 Maret 2008
Air Aspiration Test
KPPIK FKUI 20-23 Maret 2008
Trachea Incision
KPPIK FKUI 20-23 Maret 2008
Tube InsertionGauze Dressing
KPPIK FKUI 20-23 Maret 2008
KPPIK FKUI 20-23 Maret 2008