Airway Abscess & Infection
Considerations
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Emergency with risk of aspiration & acute airway obstruction
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Difficult intubation & BMV with potential for complete airway obstruction (life threatening emergency):
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Difficult topicalization
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Trismus
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Distorted anatomy, tissue edema, immobile tissue
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Copious secretions
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Potential for airway soilage from abscess rupture
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Shared airway
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Possible sepsis, pneumonia, mediastinitis & need for early goal directed therapy
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Risk factors & co-morbidities:
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Adults: HIV, IV drug use, diabetes, head & neck malignancies, alcohol
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Immunosuppression
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Pediatrics: upper respiratory tract infections
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Potential for postoperative re-obstruction post extubation & disposition to ICU/high acuity unit
Goals
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Consider pre-op abscess draining
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Secure airway safely & effectively, always consider awake fiberoptic intubation (AFOI), surgical airway, ‘double set-up’
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Manage sepsis with early goal directed therapy
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Prevent abscess rupture & lung soilage
Conflicts
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Uncooperative pediatric patient vs. difficult airway
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Full stomach & need for RSI vs. difficult airway
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Full stomach & need for RSI plus need for deep plane of anesthesia vs. risk of hemodynamic instability (sepsis)
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AFOI does not visualize ETT passing abscess & therefore potential to rupture it