Sr. Herona Bute- Black D.O.N.

E October 7th 2011

STRUCTURES OF THE RESPIRATORY SYSTEM

OBJECTIVES
At the end of 1 hrs students will be able to: 1. Define the term airway obstruction. 2. Identify causes of airway obstruction. 3. Identify clinical manifestations of airway obstruction. 4. Discuss the emergency management of an individual with airway obstruction.

Airway obstruction:

DEFINITION

partial or complete blockage of air entering

or leaving the airway.

It is a life threatening medical emergency.
In complete obstruction, permanent brain

damage/ death can occur between 3-5

minutes.
(Smelter & Bare, 2004)

CAUSES
Accumulation of foreign matter in the mouth,

throat, pharynx.
Vomit, blood, phlegm, food or a foreign object

that cannot be eliminated by coughing or

swallowing. In children, small toys are the most common foreign object to cause airway obstruction.
(Smelter & Bare, 2004)

CAUSES
State of unconsciousness as a result of relaxation of the

muscles of the lower jaw and tongue.

This obstructs the throat when the patients neck is bent

forward as flexion causes the lower jaw to sag. The tongue drops against the back of the pharynx and over the larynx causing a blockage.
(Smelter & Bare, 2004)

CAUSES
A person under the influence of alcohol or drugs.
obstruction may develop from lying on a bed

with a pillow under his head which can cause the neck to flex.
These persons experience depressed nervous

system response.
(Smelter & Bare, 2004)

CAUSES
Nasal congestion, or mucus, closure of the lips and

teeth may produce obstruction, spasm of the vocal cords.

Injury to the airway due to burns, physical trauma,

diseases/infections.
(Smelter & Bare, 2004)

CLINICAL MANIFESTATIONS
The person will/may stop breathing, speaking,

coughing or is choking. He/ she may grasp the neck with hands, (This is the universal distress signal).
Air may not flow through mouth and nose. So listen

for same.
Feel for air exchange.
(Smelter & Bare, 2004, American Red Cross, 1993)

CLINICAL MANIFESTATIONS
Noisy breathing.
This is a sign of partial obstruction. Snoring indicates air passage obstruction by the tongue as

in a flexed neck.
Crowing indicates spasms of the larynx. Gurgling sounds indicate foreign matter in the trachea e.g.

Vomit, blood.
(Smelter & Bare, 2004, American Red Cross, 1993)

CLINICAL MANIFESTATIONS
Cyanosis- due to hypoxia.

Labored breathing.
Use of accessory muscles. Nasal flaring. Increasing anxiety, Restlessness Confusion.

Loss of consciousness.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Assessment of the patient who has a foreign object occluding

the airway may involve asking the person whether he/she is

chocking and requires help.
If the patient/victim is unconscious, inspection of the

oropharynx may reveal the offending object.

Identification/ Diagnostic tests are also performed using:
Xrays Laryngoscopy Bronchoscopy.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
In the elderly, the risk for airway obstruction

is increased due to medication e.g. Sedatives, hypnotics.

Diseases affecting motor coordination (e.g.

Parkinson, CVA), and mental dysfunction (e.g. Dementia).

(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
If patient/victim can breathe and cough spontaneously, a partial

obstruction should be suspected.

Encourage the victim to cough forcefully and persistently until

the object is cough up, or goes unconscious.

After the object is removed, give rescue breaths. If no pulse is felt, begin CPR.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Establishing an airway:
may be simply repositioning the patients head to prevent

the tongue from obstructing the pharynx.

Other maneuvers may be needed.
Abdominal thrusts (Heimlich maneuver). Head-Tilt-Chin-Lift maneuver.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Jaw-Thrusts maneuver.
Inserting specialized equipment/ instruments

to open, remove foreign body or maintain airway.

(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
1. Quickly clean out the patients mouth. Use a finger

and sweep in the mouth to clear same of object/

debris, e.g. Sand, food particles.
2. Perform Head-Tilt-Chin-Lift maneuver:
Place patient in a supine position on a firm

surface. If patient is lying face down, log roll to

prevent injury to the spine.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Place one hand on the victims forehead and apply

firm backward pressure with the palm of the other

hand to tilt the head back.
Place the fingers of the other hand under the bony

part of the lower jaw near the chin and lift up. If this opens the airway and breathing begins, no other action is required.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
If not:
3.

Force air into the lungs by performing Rescue breathing. It is given to a person who is unconscious and not breathing, but has a pulse.

Pinch the victim's nose shut and make a tight seal around the victims mouth with your mouth.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Breathe slowly and gently into the victim until the chest

rises. Give 2-3 breaths.

If chest rises and falls then airway is unobstructed. If not proceed to the next step.

4. Jaw-Thrust maneuver:

Place one hand on either side of the victims jaw.

(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Grasp the angles of the victims lower jaw and lift

upward. This displaces the mandible forward. OR:

Insert thumb between the teeth, and with your finger

under the chin, pull the jaw forward.

NB. This technique is applicable if you suspect neck injury,

but not for someone having a seizure.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Give Rescue breaths (2-3), to determine if the airway is

clear. If clear, give artificial ventilation, and check for pulse.

5. If all attempts fail, suspect that the object is deep in the

throat therefore, clear air passage.

Try to reach object with your extended middle finger.
(Smelter & Bare, 2004, American Red Cross, 1993)

Remember,

if an unconscious persons airway is blocked, it is more important to get air in

than to get the object out

MANAGEMENT
Call for emergency help. 6. Proceed

to

give

abdominal

thrusts/

Heimlich maneuver.
Place thumb side of fist against the middle

of abdomen just above the umbilicus.

Grasp fist with other hand.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Give 5 upward thrusts. Repeat until the object is

coughed up or the person goes unconscious. If the victim is too big for you to reach around, or

pregnant:
Give chest thrusts; i.e. place your fist on the lower

half of the sternum instead of the abdomen.

(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Do a finger sweep and continue using the technique

for the unresponsive patient. If a child is unable to speak, cough, or breathe,

perform abdominal thrust until the object is

expelled or child becomes unconscious.
Give rescue breaths for 1 minute before calling for

help.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Check pulse every minute.

For babies and infants:

Give mouth- to- nose breathing.
Close the childs mouth. Seal your mouth around the childs nose and breathe

into the nose.

Watch chest for rise and fall.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
If victim has no pulse perform CPR. Insertion of devices:

(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Insertion of devices:
1. Oropharyngeal airway.
Used for patients who are semi- conscious or

unconscious.
Prevents the tongue from obstructing the airway.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
Oropharyngeal airways

(http://www.google.com.vc/imgres)

MANAGEMENT
2. Endotracheal Intubation (ET Tube):

Used to establish and maintain airway. Allow for attachment of a resuscitation Bag, or mechanical ventilator.

3. Combitube:

Provides pharyngeal ventilation.

(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
4. Surgery:
Cricothyroidectomy (Cricothyroid Membrane

Puncture).
Opening of the cricothyroid membrane to establish

airway.
(Smelter & Bare, 2004, American Red Cross, 1993)

MANAGEMENT
If the patient has laryngectomy (removal of the larynx): To check for breathing, look, listen and feel for breaths with your ear over the stoma. Clean the neck opening/ stoma of encrusted matter and mucus. Suction stoma by passing a catheter tube through the stoma and down into the trachea (2-3) while holding the tube kinked

MANAGEMENT
Release pressure on the tube and withdraw it to allow

suctioning. OR Mouth- Stoma Resuscitation Place mouth directly on the stoma. Breathe into the stoma at the same rate as you would breathe into the mouth 9 1 slow breaths every 5 sec.). Watch patients chest for inflow of air. Keep patients head straight with shoulders slightly elevated, avoid twisting the head as this may change stoma shape or even close the opening.

REFERENCES
American Red Cross. (1993). Community first aid and safety. USA: Mosby. Mosby (2002). Mosbys medical nursing and allied health dictionary. (6th ed.) St. Louis, Missouri: Mosby. Smelter, S. C. & Bare, B. G. (2004). Brunner and Suddarths

textbook of medical-surgical nursing. (10th ed.). Philadelphia:

Lippincott, Williams & Wilkins.