Emergency evaluation of acute upper airway obstruction in children
- Laura L Loftis, MD
Laura L Loftis, MD
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Associate Professor of Anaesthesia
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Acute upper airway obstruction from any cause can be a life-threatening emergency. Complete obstruction will result in respiratory failure followed by cardiac arrest in a matter of minutes. This situation requires an immediate, aggressive response.
In contrast, a child with a partial obstruction may initially have an adequate airway. However, this condition can deteriorate rapidly. Under these circumstances, providing supportive care and mobilizing resources for definitive airway management may be the most appropriate intervention.
Compared with adults, infants and young children have small airways and can quickly develop clinically significant upper airway obstruction. The increased work of breathing that results can rapidly progress to respiratory failure because these young patients have less respiratory reserve. Therefore, prompt recognition of airway compromise and the institution of appropriate therapy are necessary to prevent progressive deterioration in respiratory function and improve outcomes.
This topic will review an emergency diagnostic and therapeutic approach to acute severe upper airway obstruction in children. The emergent evaluation of children with acute respiratory distress and issues related to stridor, chronic upper airway problems, and airway management techniques for the difficult pediatric airway are discussed separately.
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- Decreased muscle tone
- Infectious etiologies
- - Epiglottitis
- - Croup
- - Bacterial tracheitis
- - Retropharyngeal abscess
- - Peritonsillar abscess
- - Infectious mononucleosis
- Foreign bodies
- - Airway foreign body
- - Esophageal foreign body
- - Blunt and penetrating injury
- - Burn injuries
- Hereditary angioedema
- Vocal cord dysfunction
- Acute on chronic conditions
- Initial rapid assessment
- - Upper airway patency
- - Respiratory failure
- - Onset of symptoms
- - Fever
- Physical examination
- - Signs of airway obstruction
- - Associated findings
- Ancillary studies
- - Imaging
- - Microbiology
- - Direct laryngoscopy
- ALGORITHMIC APPROACH
- No airway, complete obstruction
- - Suspected foreign body
- - No foreign body suspected
- Severe upper airway obstruction
- - Imminent decompensation
- - Fever
- - No fever
- SUMMARY AND RECOMMENDATIONS