Upper airway obstruction in the emergency department

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Target exams

Red flags

• In NAP4, 31% of major ED airway events led to death or persistent neurological injury, and failure to use capnography contributed to 74% of such outcomes
• Adult epiglottitis can progress unpredictably and a normal lateral neck radiograph does not exclude it — visualise the epiglottis
• Angioedema without urticaria or itch may be bradykinin-mediated (ACE-inhibitor or hereditary) — antihistamines and steroids are nearly useless; the airway is the priority
• Ludwig's angina can compromise the airway rapidly — call anaesthesia and ENT early and plan flexible intubating endoscopy with a surgical airway prepared
• Can't intubate, can't oxygenate — scalpel cricothyroidotomy is the fastest and most reliable rescue; it requires complete neuromuscular block