Recognising an airway problem

The best way to recognise a partial or complete airway obstruction is by looking, listening and feeling (Baskett et al.

Look

• The patient who is able to verbalise clearly has an airway that is patent and not compromised at this point.

• An agitated and/or confused patient may be hypoxic.

• A lethargic patient may be hypercarbic.

• A cyanotic and pale patient is likely to be hypoxic. The skin may also be clammy or sweaty. Note that cyanosis is often a late sign and absence of cyanosis does not mean that the patient is adequately oxygenated.

• A patient showing signs of muscular retractions, who is making use of their accessory muscles or has shallow, laboured breathing has some degree of airway compromise.

Listen

• A patient whose respiration is quiet and effortless is breathing normally.

• Noisy breathing indicates partial airway obstruction (see Table 7.2).

• If there are no breath sounds, this indicates the absence of air entry that may be due to complete airway obstruction.

Table 7.2 Obstructive airway sounds.

Characteristic

What they mean

sounds

Crowing

Laryngeal spasm or obstruction

Wheeze

An expiratory noise suggestive of lower airway obstruction

Stridor

An inspiratory noise suggestive of upper airway obstruction

Gurgling

Suggestive of liquid or semisolid foreign material in the main

airways

Snoring

Indicates the pharynx is partially occluded by the tongue or

• A patient whose chest is moving equally and quietly, exhaling warm air, is breathing normally.

• If air cannot be felt but chest and abdominal movements are obvious, this is indicative of complete airway obstruction.

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