Chapter 10- Airway Obstruction

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Chapter 10
Airway Obstruction

Objectives
• Upon completion of this chapter, you will
be able to:
– Explain several causes of airway obstruction
in the dental office
– Explain several ways to prevent airway
obstruction in the dental office
– Identify the anatomy of the airway
2

Objectives (cont’d.)
– Explain the differences between the various
types of airway obstructions
– Define the Heimlich maneuver
– Demonstrate:
• The Heimlich maneuver
• Abdominal thrusts
• Chest thrusts
• Finger sweeps
3

Objectives (cont’d.)
– Explain the use of the Heimlich on:
• Infants
• Children
• Pregnant patients
• Obese patients
– Explain the use of the cricothyrotomy
– Demonstrate how to perform the Heimlich on
oneself
4

Dental Hazards
• Important to recognize and treat airway
obstruction quickly and correctly
• Airway obstruction can occur in all ages
• Sit-down dentistry has increased incidence
of patients aspirating objects in the airway
• Objects can easily slip from the dentist’s or
auxiliary’s hand
5

Dental Hazards (cont’d.)
• Items that may produce obstructions in the
dental office:
– Tooth fragments or whole teeth
– Amalgam
– Prosthetic devices
– Crowns
– Impression materials
– Gauze or cotton rolls
6

• Protective devices such as the dental dam
or throat packs help prevent obstructions
– Some treatments make it impossible to use
these devices
7

– Auxiliary should be assertive with the use of
the high volume evacuator
• Have cotton pliers ready to retrieve any dropped
objects
• Remain calm to keep patient from overreacting if
an object is dropped
8

Anatomy of the Airway
• Most airway obstructions in the dental
office are in the upper airway
• Important to understand the anatomy of
the airway:
– Mouth and nose empty into the pharynx
(throat)
9

Anatomy of the Airway
– Two passages extend down from the pharynx
• Trachea: carries air into the lungs
• Esophagus: carries solids and liquids to stomach
• When food is swallowed, it is kept out of
the trachea by the epiglottis
– Flap that covers the opening of the trachea
10

Anatomy of the Airway (cont’d.)
– Food or other objects get past the epiglottis
• Patient can usually cough to remove the object
• Sometimes object can get lodged in the trachea
and airway is obstructed
• Upper-airway anatomy includes the larynx
(voice box)
• Lower-airway includes the bronchi, alveoli,
and lungs
11

Upper Airway Anatomy
Figure 10-1: Structures of the upper respiratory tract
12

Types of Airway Obstructions
• Partial airway obstruction
– Airway is not completely blocked
– Some air gets into the lungs
– Can be with adequate air exchange or
inadequate air exchange
• Partial airway obstruction with adequate
air exchange
– Person will cough forcibly and is able to talk
13

(cont’d.)
• Partial airway obstruction with inadequate
air exchange
– Person will not cough
– Crowing sound will be made
– The person may show signs of cyanosis
around the mouth due to lack of oxygen
– Can become a complete airway obstruction
14

(cont’d.)
• Complete airway obstruction
– Most life threatening
– Does not make noise
– May exhibit the universal distress signal,
clutching the throat with their hands
– Person usually panics very quickly and resists
treatment
15

(cont’d.)
– Patient will lose consciousness quickly if the
object is not removed
– If oxygen is lacking for 4 to 6 minutes,
irreversible brain damage can occur
– If the object is not removed, death can occur
16

The Heimlich Maneuver
• Makes use of the air that remains in the
victim’s lungs
• Pressure placed on the abdomen during
manual thrusts causes:
– Elevation of the diaphragm
– Increases pressure on the lungs
– Causes an explosive force of air to be
released and hopefully to clear the trachea
17

Classifications of Airway
Obstructions
• There are several different types of airway
obstructions
• Different techniques to treat them
18

Partial Obstruction with Adequate
Air Exchange
• Patient coughs forcibly
• Encourage patient to cough
• Object is usually expelled
19

Partial Obstruction with Inadequate
Air Exchange
• Patient is in a potentially life threatening
situation
– Obstruction is preventing the patient from
receiving oxygen
• Patient should be treated as if suffering
from a complete airway obstruction
20

Complete Airway Obstruction
• Patient cannot breathe, make sounds, and
becomes pale and cyanotic
– May die from asphyxiation in four to six
minutes
• Must be diagnosed and treated
immediately
21

Complete Airway Obstruction
(cont’d.)
• Best treatment is the Heimlich maneuver
and finger sweeps (unconscious patients
only)
22

Technique
• Manual thrusts may be administered as
abdominal thrusts or chest thrusts
– Both techniques are successful
– Chest thrusts are used with pregnant patients
or patients who are extremely obese
– Abdominal thrust can be performed on any
other patient
23

Abdominal Thrust
• Conscious patient
– Stand behind the patient
– Wrap your arms around the patient
– Make a fist with one of your hands
– Place the thumb of the fist against the
patient’s abdomen halfway between the navel
and the rib cage
24

Abdominal Thrust (cont’d.)
– Cover the fist with your other hand
– Push the fist quickly four times into the
abdomen with an inward and upward motion
25

Figure 10-3: Abdominal Thrust
26

Figure 10-4: Abdominal Thrust
27

• Unconscious patient
– Place the patient in a supine position
– Straddle the patient, facing toward the
patient’s head
• If the patient is small you may stand or kneel
alongside
– Place the heel of one hand on the patient’s
abdomen
28

– Place the other hand on top of the first hand
and interlock the fingers
– Push the heel of the hand rapidly inward and
upward four times into the abdomen
29

Chest Thrust
– Wrap your arms around the patient
– Make a fist with one hand
30

Chest Thrust (cont’d.)
– Place the thumb of the fist against the
patient’s lower sternum
• Do not to place the hands over the xiphoid
process, which could damage the liver
– Place the other hand over the fist
– Administer four quick thrusts
31

– Place the patient in the supine position
– Position yourself either beside or straddling
the patient
– Place the heel of one hand on the patient’s
lower sternum
• Do not place the hand on the xiphoid process
32

– Place the other hand on top of the first and
interlock the fingers
– Administer four quick downward chest thrusts
33

Finger Sweeps
• Wipe the patient’s oral cavity with the
fingers to discover if the obstruction can
be reached
• Performed only on the unconscious patient
• Care must be taken not to force the object
farther down
34

Finger Sweeps (cont’d.)
• Only use if objects are well into the oral
cavity and can be reached by the fingers
• Open the patient’s mouth
• Use the index and middle fingers
35

Finger Sweeps (cont’d.)
• Place the fingers at the corner of the
mouth
– Using a hooking motion, sweep across the
inside of the mouth to the other side
• Perform two finger sweeps
36

Order of the Procedure: Complete
Obstruction
– Administer four manual thrusts
– Repeat until the object is removed or the
patient loses consciousness
37

Obstruction (cont’d.)
– Place the patient in the supine position
– Open the airway
– Attempt to ventilate the patient using mouth-
to-mouth technique
– If you are unable to get air into the patient’s
lungs, reopen the airway and attempt to
ventilate again
38

– Administer four manual thrusts
– Make two finger sweeps
– Repeat the sequence until the object is
removed or surgical intervention is performed
by trained personnel
39

• Important to continue the Heimlich
maneuver even when the patient loses
consciousness
• Muscles that were constricting and holding
the object in place may relax during
unconsciousness
40

Heimlich Maneuver on Infants
and Children
• Conscious infant
– Place the infant supine on your lap or on a
firm surface
– Place the tips of your index and middle fingers
halfway between the infant’s navel and rib
cage
– Press inward and upward into the abdomen
with four quick movements
41

and Children (cont’d.)
• Unconscious infant
– Place the infant supine on your lap or on a
hard surface
– Open the airway
– Attempt to ventilate
– If no response, reopen the airway
– Attempt to ventilate
42

– Place the tips of your index and middle fingers
halfway between the infant’s navel and rib
cage
– Press inward and upward into the abdomen
with four quick movements
43

– Turn the infant onto its stomach with the head
lower than the feet and apply four back blows
between the shoulder blades
– Using the index finger:
• Perform two finger sweeps if the object is visible in
the infant’s mouth
44

– Repeat the sequence until the infant recovers
or surgical intervention is performed by
trained personnel
45

Oral Piercing
• Has been implicated in several adverse
oral conditions
• Jewelry may become dislodged and
obstruct the airway
• Dental personnel should take precautions
to avoid dislodging the jewelry
46

Patients with Special Requirements
• Some patients require adjustments in the
way the Heimlich maneuver is performed:
– Pregnant patients
• Perform chest thrusts
– Obese patients
• Manual thrusts may need to be performed from the
front of the patient
• Best to have the patient sit or lie down
47

Cricothyrotomy
• If the Heimlich maneuver is unsuccessful:
– A cricothyrotomy should be performed by a
trained individual
• Locate the cricothyroid membrane
• Make an incision in this area
• Place an item such as a suction tip or your finger
into the incision to keep the airway open
48

Performing the Heimlich on
Yourself
• If you are choking and no one is available
to help:
– Place your hands in the position described for
abdominal thrusts, and press
– Place yourself against the banister of a
stairway, corner of a sink, or arm of a chair
and press quickly against it
49

Summary
• An airway obstruction can occur at any
time
• Brain damage or death can occur very
quickly
• Dental auxiliary must recognize the
condition quickly and treat it effectively
50

Chapter 10- Airway Obstruction

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