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NHS Borders clinical guidelines
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Acute adult upper airway obstruction

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Acute adult upper airway obstruction

NHS Borders clinical guidelines

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.

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.