Laryngeal Obstruction - Upper Respiratory Airway

LARYNGEAL OBSTRUCTION

Edema of the larynx is a serious, often fatal, condition. The lar-ynx is a stiff box that will not stretch. It contains a narrow space between the vocal cords (glottis) through which air must pass. Swelling of the laryngeal mucous membranes, therefore, may close off the opening tightly, leading to suffocation. Edema of the glot-tis occurs rarely in patients with acute laryngitis, occasionally in patients with urticaria, and more frequently in patients with se-vere inflammations of the throat, as in scarlet fever. It is an occa-sional cause of death in severe anaphylaxis (angioneurotic edema).

Foreign bodies frequently are aspirated into the pharynx, the larynx, or the trachea and cause a twofold problem. First, they obstruct the air passages and cause difficulty in breathing, which may lead to asphyxia; later, they may be drawn farther down, entering the bronchi or a bronchial branch and causing symp-toms of irritation, such as a croupy cough, expectoration of blood or mucus, or labored breathing. The physical signs and x-ray find-ings confirm the diagnosis.

Medical Management

When the obstruction is caused by edema resulting from an al-lergic reaction, treatment includes administering subcutaneous epinephrine or a corticosteroid and applying an ice pack to the neck. In emergencies caused by obstruction by a foreign body, when signs of asphyxia are apparent, immediate treatment is necessary. Frequently, if the foreign body has lodged in the pharynx and can be visualized, the finger can dislodge it.

If the obstruction is in the larynx or the trachea, the nurse or other rescuer tries the subdiaphragmatic abdominal thrust maneuver (Chart 22-4). If all efforts are unsuccessful, an im-mediate tracheotomy is necessary.