Management of upper airway obstruction.

The tongue is the most common cause of upper airway obstruction, a situation seen most often in patients who are comatose or who have suffered cardiopulmonary arrest. Other common causes of upper airway obstruction include edema of the oropharynx and larynx, trauma, foreign body, and infection. The management of the patient with upper airway obstruction depends upon the cause of the obstruction, the training and skills of the rescuer, and the availability of adjuncts necessary to perform advanced airway techniques. In most cases, merely positioning the patient or performing one of the three maneuvers designed to elevate the tongue will open the airway of the comatose patient or the victim of cardiac arrest. In patients with suspected foreign body obstruction, abdominal or chest compression should be performed immediately, with digital extraction of the foreign body reserved for those in whom these maneuvers are unsuccessful. Most patients with obstruction secondary to edema, trauma, or infection can be managed initially with orotracheal or nasotracheal intubation. Intubation should be attempted prior to surgical management of the airway in most cases of upper airway obstruction. Occasionally, however, cricothyroidotomy or tracheostomy is necessary to establish an airway. The choice of technique depends primarily on the experience and skills of the rescuing physician or paramedic. In most cases, cricothyroidotomy is technically more simple and more easily performed than tracheotomy, especially for the physician who has not been trained in surgery or otolaryngology and for the nonphysician rescuer. No matter what the method employed in establishing an airway in a patient with upper airway obstruction, it must be performed quickly and a source of ventilation provided for the patient once the airway has been secured.