The airway can become obstructed for many reasons including:

• central nervous system depression

• bronchospasm

• laryngospasm (Resuscitation Council UK 2000).

In complete airway obstruction there are no breath sounds. If the patient is attempting to breathe there will be a seesaw (paradoxical) breathing pattern, with the abdomen moving in as the chest wall moves out during attempted inspiration. In the unconscious patient, obstruction of the pharynx by the tongue is the most common cause of complete airway obstruction. This is commonly, but inaccurately, known as 'swallowing the tongue' and occurs as muscle tone is lost. If the airway cannot be opened and cleared quickly by the use of the simple techniques described in Chapter 7, expert help must be summoned immediately.

Breathing is often noisy in partial airway obstruction. A conscious patient may be able to indicate that there is something wrong and there is often considerable distress. Treatment is directed at the cause and may involve simple airway opening manoeuvres with adjuncts and patient positioning, such as the recovery position. If there is no improvement or if advanced techniques, for example tracheal intubation, are required, senior help should be summoned without delay.

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