Acute adult upper airway obstruction

Warning

Aetiology

The main differential in adults is infection and malignancy although foreign bodies such as dentures should be considered in elderly patients or those with learning difficulties.

Clinical features

  • Stridor – classically inspiratory although can be inspiratory and expiratory if obstruction involves trachea.
  • Altered voice – suggest inflammation/swelling involves vocal cords.
  • Fever suggests infective cause.
  • Weight loss suggests malignancy.

Management

  • High flow oxygen
  • iv access/bloods
  • iv dexamethasone 6.6mg
  • iv ceftriaxone 2g
  • iv metronidazole 500mg
  • Nebulized adrenaline 1mg in 5mls of normal saline
  • Urgent anaesthetic review and ENT review if available
  • If patient completely obstructs and loses consciousness prior to ENT/anaesthetic review for surgical cricothyroidotomy.

Editorial Information

Last reviewed: 18/09/2023

Next review date: 18/09/2026

Author(s): Carr E.

Version: 1

Author email(s): esmond.carr@nhs.scot.

Approved By: McCarthy C

Reviewer name(s): Carr E.