Introduction

Overview of importance of understanding airway and breathing for patient stability. Emphasis on monitoring vital signs and patient appearance.

Key Concepts in Airway Management

Airway and Breathing Focus

• Importance of maintaining patency (being open) of airway and understanding obstructions.

• Conditions particularly affecting patency:

  • Infections: Can lead to respiratory problems, often characterized by cough, fever, or difficulty breathing. Common infections include viral croup and bacterial tracheitis, which can cause significant airway inflammation.

  • Foreign Body Aspiration: Common in children, leading to immediate airway blockage from small objects such as hot dogs or toys. Symptoms include choking, coughing, and cyanosis.

  • Angioedema: Swelling due to blood vessel dilation, often triggered by allergic reactions or medications, presenting as swelling of the face, lips, and tongue, which can obstruct the airway.

Understanding Patency

• Definition of Patency: The state of being open; crucial for airways, blood vessels, and bowels.

• Importance of an open airway for airflow and avoiding obstructions.

Causes of Airway Obstruction

Common Factors

• Infections: Can swell and obstruct the airway. Conditions like epiglottitis can occur with Haemophilus influenzae type b (Hib) infection and lead to severe airway obstruction in children.

• Foreign Body Aspiration: Can lead to immediate airway blockage. Symptoms may include acute respiratory distress and unilateral wheezing if the object is lodged.

• Angioedema: Swelling of tissues, exacerbated by allergies (e.g., pollen exposure). Can rapidly worsen and create an emergency situation.

Physiological Impact

• Histamine's Role: In allergic reactions, it causes vasodilation and increases airway swelling. Mediators like leukotrienes also contribute to bronchospasm in conditions such as asthma.

• Edema: Swelling from water accumulation in tissues due to increased capillary permeability during angioedema, leading to potential airway compromise.

Pediatric Considerations

Unique Features of Pediatric Airways

• Smaller airway diameter in infants increases risk of airway issues. Example: Infant trachea is approximately the size of their pinky finger, heightening the danger of obstruction.

Risks for Children

• Obstructive Sleep Apnea: Due to enlarged tonsils and adenoids, obstructing airway during sleep, leading to fragmented sleep and potential growth issues.

• Trauma Impact: Physical injuries can lead to airway obstruction through spasms or swelling, requiring immediate assessment and potential surgical intervention.

Signs and Symptoms to Monitor

• Physical Indicators:

  • Change in breathing patterns (e.g., snoring, unusual respiratory effort).

  • Clinical signs like skin color changes (e.g., pale/sweaty).

  • Tripod position indicating severe respiratory distress.

Important Notes on Patient Response

• Children can appear stable while being critically ill due to compensation mechanisms.

• Need for immediate readiness for advanced airway management.

Specific Respiratory Conditions

Croup (Laryngotracheobronchitis)

• Common in young children, presents with barking cough and inspiratory stridor caused by swelling due to viral infection. Severe cases may require hospitalization for close monitoring and interventions.

Bacterial Tracheitis

• Can cause severe airway obstruction, often requiring culture for diagnosis and treatment. Characterized by high fever and thick purulent secretions causing respiratory distress.

Asthma and Reactive Airways

• Caused by hypersensitivity reactions leading to bronchoconstriction, mucus production, and airway inflammation. Exacerbations can be triggered by allergens, exercise, and infections.

Treatment Options

General Interventions

• Steroids: To reduce inflammation (e.g., Celestone, Decadron). Used for both croup and asthma exacerbations.

• Nebulized Treatments: For significant edema and respiratory distress (e.g., nebulized epinephrine).

• Oxygen: A safe first line treatment for respiratory distress, promoting adequate oxygenation.

Monitoring and Support

• Constant patient evaluation is essential; respiratory failure can develop rapidly, necessitating close observation.

• Chest physiotherapy and supportive measures to clear mucus in conditions like cystic fibrosis, where thick mucus obstructs the airways.

Conclusion

Prepare for emergencies; anticipate patient needs and act proactively. Understand that airway management requires swift assessment and timely interventions.