AKT · ENT/Throat & airway

Airway compromise / stridor

Partial/complete upper-airway obstruction (multiple causes)

Overview

Obstruction of the upper airway — an emergency along the ABCDE pathway. STRIDOR (a harsh inspiratory noise) signals significant upper-airway narrowing. Causes span epiglottitis, anaphylaxis, foreign body, croup, deep-neck infection, trauma and tumour. The priority is recognising it and securing the airway, not diagnosing the cause first.

Recognise

Inspiratory STRIDOR, respiratory distress (accessory muscles, tracheal tug, recession), drooling, agitation then exhaustion
Voice change/hoarseness, cyanosis and falling consciousness are late, ominous signs
Context points to the cause: urticaria/angioedema (anaphylaxis), toxic+drooling (epiglottitis), choking (foreign body), barking cough (croup)

Red flags

Exhaustion, cyanosis, falling GCS, silent chest = peri-arrest airway → immediate senior airway support

Differentials & how to tell them apart

Anaphylaxisrapid onset with urticaria/angioedema/wheeze + hypotension → IM adrenaline (see Acute care)

Epiglottitistoxic, drooling, tripod — airway first, do not examine the throat

Inhaled foreign bodysudden choking, often a child — back blows/abdominal thrusts

Croupbarking cough, hoarse, less toxic — oral dexamethasone

Investigations

Do not delay airway management for investigations. Identify reversible causes fast (anaphylaxis, foreign body). Definitive airway assessment in a controlled setting.

Management

ABCDE — secure the airway (senior anaesthetics/ENT) + treat the reversible cause

1ABCDE with high-flow oxygen; call for senior anaesthetic/ENT help early. Treat an obvious reversible cause immediately — IM adrenaline for anaphylaxis, the choking algorithm for a foreign body.Gate: In suspected EPIGLOTTITIS or a critical airway, do NOT distress the patient (no throat exam, no forced cannulation) before senior airway support is present — securing the airway in a controlled setting takes priority over diagnosis
2Definitive airway (intubation, or surgical airway/tracheostomy if "can't intubate, can't ventilate"); then treat the underlying cause.

IM adrenaline — immediately if anaphylaxis is the cause

Oxygen + senior airway support (anaesthetics/ENT) — definitive management of the airway

Nebulised adrenaline + dexamethasone — temporising in croup/oedema

Back blows / abdominal thrusts — choking algorithm for a foreign body

Key points

Stridor = significant upper-airway narrowing → get senior airway help early. Match the quick clues to reversible causes (anaphylaxis, foreign body) while preparing the airway. Cross-references Acute care (anaphylaxis/ALS).

Monitor & prognosis

Airway patency, oxygenation, work of breathing, GCS.

Depends on cause and speed of securing the airway.

Source: Resuscitation Council UK; NICE