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Management of Acute Airway Obstruction
An acute upper airway obstruction (UAO) is a blockage that occurs in your upper airway. The upper airway of your respiratory system consists of the trachea, larynx or voice box, and throat. A blockage in your airway could prevent your body from getting enough oxygen. A lack of oxygen can cause brain damage, and even a heart attack, in a matter of minutes. Any obstruction of the upper airway has the potential to be life-threatening. Seek emergency medical attention immediately if you suspect that you, or someone you know, has an obstructed upper airway.Acute airway obstruction (the foreign body either completely obstructs the pharynx or acts as a valve on the laryngeal inlet), no warning signs, most frequently in a child 6 months-5 years playing with a small object or eating. Conscience is initially maintained. Perform maneuvers to relieve obstruction only if the patient cannot speak or cough or emit any sound: Children over 1 year and adults: Heimlich manoeuvre: stand behind the patient. Place a closed fist in the pit of the stomach, above the navel and below the ribs. Place the other hand over fist and press hard into the abdomen with a quick, upward thrust. Perform one to five abdominal thrusts in order to compress the lungs from the below and dislodge the foreign body. Children under 1 year: Place the infant face down across the forearm (resting the forearm on the leg) and support the infant’s head with the hand. With the heel of the other hand, perform one to five slaps on the back, between shoulder plates. If unsuccessful, turn the infant on their back. Perform five forceful sternal compressions as in cardiopulmonary resuscitation: use 2 or 3 fingers in the center of the chest just below the nipples. Press down approximately one-third the depth of the chest (about 3 to 4 cm).
About the Speaker
Dr Pooja Wadwa
Additional Director, Critical Care Medicine, ECMO specialist,FMRI,Gurgoan
Upcoming CME Events
Public Expectations and Misunderstandings About Critical Care
Public Expectations and Misunderstandings About Critical Care often revolve around the perception of medical interventions and outcomes in intensive care units (ICUs). Many people believe that advanced medical technologies and treatments can invariably save lives or fully restore health, underestimating the complexities and limitations of critical care. This misunderstanding is partly fueled by media portrayals of medicine, where recovery is often rapid and complete. In reality, critical care outcomes can vary greatly, with some patients experiencing long-term physical, cognitive, and psychological effects post-ICU. Additionally, there's a lack of awareness about the nature of end-of-life care in ICUs, leading to unrealistic expectations about the effectiveness of life-sustaining treatments. This gap in understanding underscores the need for better public education about the realities of critical care, the potential outcomes, and the importance of advance care planning.
ECHO & Ultrasound guided hemodynamic management in ICU
Bedside echocardiography (ECHO) and ultrasound play a crucial role in hemodynamic monitoring and management in the intensive care unit (ICU). They are non-invasive techniques, reducing the risks associated with invasive procedures while offering valuable insights into cardiac function. ECHO and ultrasound help evaluate intravascular volume, guiding the administration of fluids in critically ill patients to optimize cardiac output. These tools allow assessment of cardiac contractility, ejection fraction, and valvular function, aiding in the management of heart-related issues. ECHO and ultrasound are instrumental in diagnosing conditions like pericardial effusion, tamponade, cardiomyopathy, and structural heart defects in ICU patients. In some cases, ECHO and ultrasound can replace more invasive monitoring techniques, like pulmonary artery catheters, for hemodynamic data. They help monitor the effects of interventions, such as medication administration, fluid boluses, or mechanical ventilation adjustments. ECHO and ultrasound can guide procedures like central line placement, thoracentesis, or pericardiocentesis, reducing the risk of complications. ECHO and ultrasound allow evaluation of not only the heart but also other organs, including the lungs and abdomen, providing a comprehensive view of a patient's condition.
Role Played by ECMO in Critical Care
Extracorporeal Membrane Oxygenation (ECMO) plays a pivotal role in critical care, providing advanced life support for patients with severe cardiac or respiratory failure. By temporarily assuming the function of the heart and lungs, ECMO allows vital organs to recover, offering a crucial bridge to recovery or transplant. Its capacity to maintain oxygenation and circulation in critically ill patients underscores ECMO's significance as a lifesaving intervention in the intensive care setting.
ICU Management of Interstitial Lung Disease
The intensive care unit (ICU) management of interstitial lung disease (ILD) involves addressing respiratory distress, optimizing oxygenation, and treating underlying causes, such as infections or exacerbations. Mechanical ventilation strategies, including positive end-expiratory pressure (PEEP) and lung-protective ventilation, are employed, and meticulous attention is given to fluid balance and hemodynamic stability. Corticosteroids and immunosuppressive agents may be used for specific ILD types, and collaborative efforts between pulmonologists and intensivists are crucial for tailored care, monitoring complications, and achieving optimal outcomes in critically ill ILD patients.
Ventilator-associated pneumonia (VAP) is a serious and potentially life-threatening infection that occurs in individuals who are on mechanical ventilation in hospitals. Patients on ventilators are often at an increased risk due to the invasive nature of the equipment and compromised respiratory function. VAP results from the colonization of the respiratory tract by harmful bacteria, which can lead to inflammation and infection. Preventive measures, such as maintaining proper hygiene, elevating the head of the bed, and minimizing the duration of ventilation, are crucial in mitigating the risk of VAP. Timely diagnosis and appropriate antibiotic treatment are essential for managing VAP and preventing further complications in critically ill patients. Healthcare providers closely monitor patients on ventilators to promptly identify and address signs of pneumonia, emphasizing the importance of infection control practices in intensive care settings.