A patient with an obstructive breathing pattern typically has respiratory distress characterized by labored inspiration and abnormal upper airway noise such as stridor or stertor (See Figure 23).

  • Common causes in trauma patients are facial and oropharyngeal swelling (jaw fractures, facial trauma), cervical injury (tracheal compression by hemorrhage in neck area, muscle edema), direct tracheal injury, severe snake and insect envenomation, bite wounds, smoke inhalation, electrocution, and foreign objects.
  • Diagnosis is usually obvious based on history of trauma and presenting signs. For every trauma patient, carefully ensure the airway is open by physically opening the mouth, examining the oral cavity, and watching the patient breath. Palpate and examine the face, muzzle, nose, mouth, external laryngeal area, and trachea for deformities, traumatic wounds, or other abnormalities
  • If the airway is not patent, immediately takes steps to open the airway (See Figure 25).
    • Provide oxygen therapy as above.
    • Bypass the obstruction until the patient is more stable:
      • Attempt to remove the obstruction quickly by sweeping the mouth and pharyngeal area with a finger or gauze, suction the area, or use large forceps to remove objects that may be obstructing the passage.
      • Do not attempt a Heimlich maneuver unless you know the object is smooth (e.g., ball); most trauma patients do not have a smooth foreign body obstruction, and the maneuver can cause significant patient distress and possibly further injury.
  • If the obstruction cannot be removed in a few seconds, consider tracheal insufflation with oxygen for immediate oxygen delivery (See Table 4 for technique), and perform an emergency tracheostomy (See Table 5 for technique).
  • Patient anxiety is frequently a compounding factor; tranquilize, sedate, or anesthetize if necessary.
  • Management of patients with tracheostomy tubes requires 24-hour care and observation. Perform tracheal and pulmonary toilet as for human patients. Perform local wound care at least every 12 hours. Tube dislodgement is a potentially life-threatening complication that must be guarded against and monitored.

 

Figure 25.  Airway Obstruction Management Algorithm for MWDs.

Figure 25.  Airway Obstruction Management Algorithm for MWDs.