Airway compromise

Airway support and ventilatory assistance in patients with a depressed level of consciousness or airway compromise... 

Facial and neck injuries may predispose the victim to airway and ventilatory difficulty. Airway compromise may result if the patient with facial fractures remains in a supine position due to lack of bony support. Progressive airway obstruction may also result from hemorrhage from penetrating neck wounds. Bleeding into the trachea, bronchus, and lungs will all compromise the victim s airway and ventilatory status. An artificial airway should be placed to maintain airway patency until intubation is required (American College of Sur-... 

The most serious side effect of the opioids is respiratory depression.The narcotic agonists suppress the brainstem respiratory centers and thus alter tidal volume, respiratory rate, rhythmicity, and responsiveness to CO2. When used in equianalgesic doses, the opioids, with the exception of pentazocine, produce similar degrees of respiratory depression.Therapeutic doses of opioid analgesics are unlikely to produce significant respiratory depression in most healthy patients.The opioids must be used with caution, however, in patients with preexisting pulmonary disease, especially patients with airway compromise such as chronic obstructive pulmonary disease. 

Perez J, Burton BT, McGirr JG. Airway compromise and delayed death following attempted central vein injection of propylhexedrine. J Emerg Med 1994 12(6) 795-7. 

The only patient exposed to vesicant that may be classified as needing immediate treatment is that individual whose airway is compromised. A hoarse, high-pitched, crowing sound (croup-like) on inspiration, accompanied by retraction of the neck and accessory muscles of respiration, coupled with unusual inspiratory airway sounds, and possibly cyanosis (blue color) of tissues, indicates airway compromise at the level of the glottic opening. This can only be remedied with immediate securing of the airway with endotracheal intubation. 

Oral mucosa 30%-50% May try antifibrinolytic or topical thrombin prior to factor replacement for minor bleeding higher factor levels may be needed for tongue swelling or risk of airway compromise antifibrinolytic therapy should be used following factor replacement do not use with APCCs or PCCs... 

Unless airway compromise requires immediate need for intubation, facihtate rapid assessment of NIH Stroke Scale by stroke team prior to intubation... 

Observe closely for evidence of upper respiratory tract edema, which is heralded by a hoarse voice and stridor and may progress rapidly to complete airway obstruction. Endotracheally intubate patients who show evidence of progressive airway compromise. 

A. Thermal and irritant effects include singed nasal hairs, carbonaceous material in the nose and pharynx, cough, wheezing, and dyspnea. Stridor is an ominous finding that suggests imminent airway compromise due to swelling in and around the larynx. Pulmonary edema, pneumonitis, and adult respiratory distress syndrome (ARDS) may occur. Intimation of steam is strongly associated with deep thermal injury but is not complicated by systemic toxicity. 

Nouraei SA, Obholzer R, Ind PW, et al. Results of endoscopic surgery and intra-lesional steroid therapy for airway compromise due to tracheobronchial Wegener s granulomatosis. Thorax 2008 63(l) 49-52. 

Facial and laryngeal edema Intubation in the setting of airway compromise high-flow supplemental oxygen inhaled P2-agonist epinephrine (s.c./i.v.), antihistamine (i.v.), corticosteroid (i.v.), diphenhydramine (i.v.)... 

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