Скачать или смотреть UPPER AIRWAY OBSTRUCTION _ DR KUSHAL KALVIT ( hod ccm medanta indore)

00:00:00 intro
00:02:00 anatomy
00:04:20 mechanics
00:08:49 assessment
00:12:00 causes
00:18:50 management
00:21:40 NAP 4
Upper Airway Obstruction
Dr. Kushal Kalvit , a consultant at MEDANTA Hospital and a fellowship-trained critical care specialist from the UK, delivered a comprehensive lecture on upper airway obstruction, emphasizing its critical nature as a life-threatening emergency, particularly in pediatrics. He detailed the anatomical differences between adult and pediatric upper airways, highlighting the unique challenges in children due to their smaller structures and immature cartilage. Kushal explained the mechanics of upper airway obstruction, distinguishing between variable extrathoracic, variable intrathoracic, and fixed obstructions, and their respective effects on inspiratory and expiratory flows, which result in stridor and wheezing. The session concluded with an overview of the clinical presentation and management strategies for upper airway obstruction, underscoring the importance of understanding these mechanics for effective intervention.

Assessing Upper Airway Obstruction
Kushal discussed the importance of quickly assessing upper airway obstruction, emphasizing that the severity must be continuously monitored as it can rapidly worsen. He outlined three key parameters for assessment: the effort of breathing, the efficacy of breathing, and the effect of respiratory failure on other systems. Kushal stressed the need to observe respiratory rate, recessions, accessory muscle use, flaring nostrils, chest expansion, breath sounds, oxygen saturation, and the patient's overall condition without disturbing them, particularly in children.

Causes and Management of Airway Obstruction
Kushal discussed the causes of acute upper airway obstruction, highlighting four common factors: trauma, inhalational injury, tumor, and foreign body, which can occur at any level of the airway. Site-specific reasons for obstruction include epiglottitis, neck abscesses, Ludwig's angina, and allergic edema in the supraglottic region; bilateral vocal cord paralysis in the glottic region; and subglottic stenosis in the subglottic region. Kushal emphasized that while various causes exist, the basic principles of airway management are consistent across all scenarios, and he planned to discuss the management of these conditions in more detail.

Pediatric Respiratory Conditions Overview
Kushal discussed the clinical presentation and diagnosis of three pediatric respiratory conditions: croup, bacterial tracheitis, and epiglottitis. He explained key distinguishing features including age groups, clinical appearances, and diagnostic methods. For croup, Kushal recommended dexamethasone and nebulized epinephrine. For bacterial tracheitis and epiglottitis, which require urgent airway management, Kushal advised immediate transfer to the operating room for bronchoscopy or intubation, along with antibiotic treatment.

Pediatric Airway Management Guidelines
Kushal discussed the management of airway obstruction in pediatric patients, emphasizing the importance of initial assessment without disturbing the child. He advised against unnecessary interventions like IV access, blood tests, or imaging at the initial stage, and highlighted the use of inhalational induction as the preferred method for airway management. Kushal also stressed the need for senior anesthetists and surgical staff to be involved, identified the level of obstruction, considered awake nasal endoscopy if investigations are unavailable, and avoided multiple attempts at direct laryngoscopy.

Airway Management Strategies and Challenges
Kushal discussed airway management strategies, emphasizing the importance of patience during inhalational induction and the potential failure of both inhalational and intravenous induction methods. He highlighted the challenges of emergency cricothyroidotomy in pediatrics and the need for a plan in case of accidental tube dislodgement or removal in ICU patients. Kushal also recommended considering THRIVE (Transnasal Humidified Rapid Insufflation Ventilatory Exchange) as a high-flow nasal cannula option for airway manipulation, providing both oxygenation and ventilation.

Upper Airway Obstruction Conditions
Dr. discussed various conditions that can cause upper airway obstruction, including retropharyngeal abscesses and angioedema, emphasizing the importance of proper diagnosis and treatment. He highlighted that younger patients, particularly young boys, often present with symptoms like cough and difficulty swallowing, and should not be dismissed lightly. Dr. also explained the mechanics of airway obstruction, noting that once a patient is intubated, the classic findings of obstruction may not be present. He concluded by discussing the sounds associated with different types of obstruction and encouraged Kushal to ask any questions if needed.