Choking

Alternative names

Airway obstruction - acute upper; Acute upper airway obstruction

Definition

An acute upper airway obstruction is a blockage of the upper airway, which can be in the trachea, laryngeal (voice box), or pharyngeal (throat) areas.

Causes, incidence, and risk factors

Acute upper airway obstruction may have any of a number of causes including viral and bacterial infections, fire or inhalation burns, chemical burns and reactions, allergic reactions, foreign bodies, and trauma. The blockage can be complete or partial. Mild obstruction may result in air hunger, while more severe obstruction can lead to cyanosis and confusion or unconsciousness. Complete obstruction, if not corrected, leads to rapid suffocation and death.

Symptoms of acute upper airway obstruction are dramatic and easy to diagnose. The individual may suddenly begin having difficulty breathing or be unable to breathe at all. Cyanosis, unconsciousness, and death may rapidly follow significant partial or total obstruction.

Common causes of acute upper airway obstruction include:

• Foreign bodies
  o In adults, foreign bodies are usually aspirated chunks of meat or food. In children, peanuts are the most commonly aspirated food, but hot dogs are the most common food item associated with aspiration fatalities, because of their size and shape. Children also aspirate or choke on many nonfood items. Airway obstruction from aspirated balloon fragments, buttons, coins, and small toys is common.
  
• Anaphylaxis
  o Acute allergic reactions in which the trachea and/or throat swell closed are a common cause of airway obstruction. The classic example is an allergic reaction to a bee sting, which frequently takes the form of an anaphylactic reaction. Other common causes include allergy reaction to peanuts, antibiotics (penicillin), and blood pressure medications (group called ACE inhibitors).
  
• Croup
  o Croup may lead to a fairly rapid decrease in airway diameter and marked respiratory distress.
  
• Epiglottitis
  o Acute bacterial epiglottitis can cause rapid airway obstruction as the epiglottis swells and occludes the airway. Acute epiglottitis is preventable by vaccination against H. influenza bacteria.
  
• Retropharyngeal abscess
  o A rapidly expanding abscess can block the airway and cause respiratory distress.
  
• Peritonsillar abscess
  o Obstruction similar to retropharyngeal abscess.
  

Symptoms