You are called to see a 47-year-old man who has been admitted to your ward having been found slumped on the pavement after a night on the town. He is making snoring noises and the nurse is concerned that his airway may be compromised. You start to assess the patient using the ABCDE approach.
As you approach, you hear him making a harsh gurgling noise, which seems to emanate from his upper airway every time he breathes.
If at any point you feel out of depth or you are concerned about the patient, what should you do?
Call for help.
Observing the patient from the end of the bed, what features might make you suspect an airway obstruction?
Paradoxical breathing pattern, added noises such as snoring, gurgling (partial airway obstruction).
Assuming this patient’s airway is obstructed, what simple manoeuvres could you try?
Head tilt with chin lift or jaw thrust
You attempt these manoeuvres. The gurgling noise disappears and his breathing pattern improves. However, when you stop the manoeuvre, the noise returns, you see the saturations start to drop once more and the abnormal paradoxical breathing pattern return.
Do you know of any simple airway devices or ‘adjuncts’ which can aid in maintaining an airway?
Oropharyngeal or nasopharyngeal airway. Remember history doesn't exclude trauma, need to use nasopharyngeal airway with caution as contraindicated in base of skull.
You place one of these airway adjuncts and this helps. The patient’s airway now appears to be patent.
What features, if present, would alert you that the patient was experiencing an anaphylactic reaction?
Sudden deterioration, rash, urticaria, airway swelling, wheeze, cardiovascular collapse.
Other than high flow Oxygen (O2,) what drug would you immediately consider giving?
Adrenaline (0.5 mls of 1:1,000 intramuscular).
The patient stops breathing and requires assisted ventilation.
What equipment can you use to provide breaths for the patient, and at what rate would you do this?
Bag and mask at a rate of 10-12/minute.