Assume stridor means partial obstruction until proven otherwise; look for angioedema, foreign body, infection (epiglottitis, Ludwig, retropharyngeal), tumor, trauma, or post-extubation edema.
For a threatened airway, get experienced airway help early and decide whether an awake technique preserving spontaneous ventilation is safest. Avoid unplanned sedation or paralysis before a workable oxygenation and rescue plan. If an induced intubation/CICO pathway is required, use the appropriate neuromuscular-blockade strategy.
Treat airway oedema according to its cause. Nebulized adrenaline and systemic corticosteroids may temporize inflammatory/post-extubation oedema; bradykinin-mediated angioedema may not respond. Heliox can be a bridge in selected obstruction, but none of these measures replaces timely airway protection.
When you can't intubate and can't ventilate → cricothyroidotomy.
DAS 2025: videolaryngoscopy on the first attempt, with apnoeic oxygenation (HFNO) during the attempt.
Investigations
First tests: Airway assessment with senior airway/ENT help.
Only if indicated: Flexible nasendoscopy / laryngoscopy, CT neck with contrast, Arterial blood gas.
Repeat monitoring: Continuous oxygenation and clinical reassessment.
Management pathways in this chapter
Managing the Patient With Airway Obstruction
Locked
The pathway step by step, with its decision points
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.