Surgical emergencies: Ear, nose, and throat emergencies
Nigel Beasley, Ashok Handa, Adam Jones, and Kevin Turner explain how to deal with some ENT emergencies
Loss of the airway is a frightening event for a patient, but the treatment options are relatively simple: unblock the airway or bypass the obstruction. The tricky part is recognising that a patient in severe respiratory distress has stridor and is not asthmatic. Two other conditions which can cause concern are severe persistent epistaxis, which may result in haemodynamic shock, and otalgia caused by the potentially serious intracranial complications of acute mastoiditis.
The most obvious cause of upper airway obstruction is an inhaled foreign body. This can be dislodged by suddenly increasing the intrathoracic pressure and forcing the obstruction out like a cork from a bottle. This is done by using Heimlich's manoeuvre: stand behind the patient and grasp him or her around the upper abdomen; an upward thrust in the epigastric region may dislodge the offending article.
Telling the difference between stridor and other causes of severe respiratory distress,