Blocked Airway: Upper Obstruction

• Assume stridor means partial obstruction until proven otherwise; look for angioedema, foreign body, infection (epiglottitis, Ludwig, retropharyngeal), tumor, trauma, or post-extubation edema.
• Never sedate or paralyze a tenuous airway; choose awake intubation or have ENT present for a surgical airway.
• Edema responds to nebulized adrenaline and IV steroids; heliox can bridge stenosis.
• When you can't intubate and can't ventilate → cricothyroidotomy.
• DAS 2025: videolaryngoscopy on the first attempt, with apnoeic oxygenation (HFNO) during the attempt.

Managing the Patient With Airway Obstruction

• Airway obstruction suspected from history and physical: biphasic stridor and wheeze (subglottic lesion or below the glottis) · inspiratory stridor (lesion at or above glottis) · impaired phonation · poor air entry · suprasternal retractions · universal choking sign · respiratory distress · tachycardia · agitation · angioedema · neck swelling · wheezing
• Awake and breathing?
• Try to localize the cause by history and examination · assemble difficult-airway personnel (anesthesia, ENT) · assemble intubation equipment and a tracheostomy tray
• Consider operating room transfer to optimize equipment and personnel · careful indirect laryngoscopy or fiberoptic nasopharyngolaryngoscopy
• Management guided by diagnosis · heliox or BiPAP usable when etiology is not progressive · close monitoring
• Unconscious patient or impending respiratory arrest: call for help to assemble difficult-airway personnel (anesthesia and/or ENT)
• Head tilt–chin lift · jaw thrust (if C-spine unstable) · place an oral or nasal airway · bag-valve mask ventilation
• Attempt direct laryngoscopy and endotracheal intubation · surgical airway (bedside tracheostomy) · cricothyroidotomy or needle cricothyrotomy when no personnel are available for a bedside surgical airway
• Further management per etiology