Recognition and management of airway emergency
Learning theme: Supraglottitis
Supraglottitis usually presents with a short history of sore throat with rapid development of hoarseness, dysphagia or odynophagia. The patient may be drooling if symptoms are severe enough to prevent them swallowing their own saliva. Signs of respiratory distress, such as tachypnoea and stridor, are worrying features.
The patient’s throat should not be formally examined until senior input arrives as this may irritate the area and make the oedema worse leading to a sudden complete airway obstruction. In an adult, a senior ENT surgeon will perform flexible nasolayngoscopy to examine the throat, which will reveal an erythematous, swollen supraglottis. In paediatric cases, this should not be attempted as children will not tolerate the procedure and the examination will only cause distress possibly leading to sudden airway collapse.
- Start resuscitation with ABCDE approach.
- Escalate to ENT and anaesthetics registrars.
- Start nebulised adrenaline (1:1000 dilution) and give IV dexamethasone. Heliox is also an option if available. Heliox is a mixture of helium and oxygen, which means Heliox is less dense than air. This makes Heliox easier to breathe compared to air.
- If the patient is pyrexic, take blood cultures and start IV antibiotics (3rd generation cephalosporins). Isolated organisms include Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, or Neisseria meningitides. No attempt should be made to obtain a supraglottic swab.
- Carefully monitor observations, in particular oxygen saturation and respiratory rate.
- Definitive airway: endotracheal intubation or emergency surgical airway (emergency tracheostomy or cricothyroidotomy).