Outline the role of monitoring in the management of upper airway obstruction.
Monitoring should be considered as either part of routine examination (clinical monitoring) or requiring additional equipment or investigations. Assumed in this case that the presence of an endotracheal tube or tracheostomy would prevent upper airway obstruction.
Clinical: essential part of monitoring. Clinical criteria more likely to lead to decision to intervene. Consider importance of assessment of level of consciousness, extent of obstruction (soft tissue iodrawing- suopraclivular, tracheal tug, intercostal muscles), and ability to cope with increased work of breathing (tachycardia, tachypnoea, sweating).
Equipment: pulse oximetry (limited information, better with lower FlO2),
ECG (rhythm, ischaemia), capnograph (respiratory rate, pattern of expiratory flow), invasive pressures (IA/CVP/PAWP - may help assess extent of intrathoracic pressure change and therefore work of breathing).
Investigations: arterial blood gases (direction of change may assist in decision to intervene eg. CO2/pH).
it is difficult to come up with a systematic answer to this weird question.
Upper airway obstruction ca potentially result in the loss of the whole airway, and this would manifest in a number of ways.
Physical examination findings (such as worsening stridor or tachypnoea) suggest that this patient should undergo serial examinations.
The earliest machine-monitored sign that the patient cannot breathe (or that the airway is closing) would be continuous capnometry.
Pulse oximetry would alert you to when it is already too late, and the patient is desperately hypoxic.
ABG analysis will tell you when the patient is tiring of breathing though their obstructed airway, and this may lead you to finally intubate them.