🚨 Airway Obstruction

Airway obstruction is a life-threatening emergency where the passage of air to the lungs is partially or completely blocked. It can be caused by foreign bodies, trauma, infection, anaphylaxis, or oedema. Rapid recognition and intervention are paramount to prevent hypoxia and cardiac arrest.

Look for signs of respiratory distress: paradoxical chest and abdominal movements, use of accessory muscles, cyanosis, and altered conscious level. Listen for noisy breathing (stridor, gurgling, snoring) or complete silence if obstruction is complete. Ask 'Are you choking?' if conscious.

A: Assess for patency. Look, listen, and feel for air movement. Identify cause (e.g., foreign body, tongue, vomit). B: Assess respiratory rate, SpO2, and work of breathing. C: Assess heart rate and blood pressure. D: Assess conscious level (AVPU/GCS). E: Look for signs of trauma, swelling, or rash.

Complete absence of breath sounds, inability to speak or cough, cyanosis, rapidly deteriorating conscious level, or cardiac arrest. These indicate severe or complete obstruction requiring immediate, aggressive intervention.

Bedside: SpO2, ECG. Imaging: Lateral neck X-ray or flexible laryngoscopy may be considered if stable and cause is unclear (e.g., epiglottitis), but should not delay immediate management in an unstable patient. No investigations should delay securing the airway.

If conscious with partial obstruction, encourage coughing. If conscious with complete obstruction, perform up to 5 back blows, then up to 5 abdominal thrusts (Heimlich manoeuvre). If unconscious, start CPR immediately. Consider airway adjuncts (oropharyngeal/nasopharyngeal airway), suction, or advanced techniques (laryngoscopy, intubation, cricothyroidotomy) if basic measures fail.

Any patient with significant airway obstruction requires immediate senior medical and anaesthetic review. Failure of basic manoeuvres, inability to maintain airway patency, or the need for advanced airway interventions (e.g., intubation, surgical airway) mandates urgent critical care involvement.

The most common cause of airway obstruction in an unconscious patient is the tongue. In conscious adults, a foreign body is common. Differentiate between partial (coughing, stridor) and complete (no sound, no air movement) obstruction. Always start CPR if the patient becomes unconscious from airway obstruction.