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Compromised airway

Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Immunology, Intensive Care Medicine, Otorhinolaryngology, Anaesthesiology
Progress Test Topic(s)
ENT, Seriously ill patient
Description
A 54 year old Tongan man with known nut allergy presents with difficulty breathing. His throat feels swollen and he is very distressed. It all started when he ate at a restaurant.
Applied Science for Medicine 
   - Anatomy of the entire airway-upper and lower; microanatomy of airways
   - Cellular and cytokine controls of inflammation
   - Different types of hypersensitivity reaction
   - Physiology of acute airway obstruction; intra- vs extra-thoracic, focal vs diffuse airflow obstruction
   - Microbiology of haemophilus influenza B
   - Pharmacology of antihistamines and adrenaline; cross-reactivity of medications
Clinical and Communication Skills 
   - Recognise, assess and manage a compromised airway, including maneouvres, adjuncts and definitive airways
   - History or a collateral history for a patient with breathing difficulties
   - Communicate in a way that enables the patient to keep as calm as possible
   - Take an allergy history
   - Examination of a patient with breathing difficulties; recognise the signs impending airway obstruction
   - Differential diagnosis of upper airway compromise
   - Indications for laryngoscopy, flexible bronchoscopy, surgical airway manoeuvres, C1 esterase, antigen-specific IgE
   - Interpret full blood count, serum tryptase, serum lactate, arterial blood gas, blood cultures, sputum cultures, C1 esterase levels , antigen-specific IgE
   - Perform arterial blood gas and intramuscular injection
   - Management of anaphylaxis, epiglottitis, angioedema and foreign body obstructing an airway
   - Indications for an adrenaline autoinjector (such as EpiPen) and medical alert bracelet
   - Educate, at an appropriate time, about prevention of anaphylaxis and self-management
Personal and Professional Skills 
   - Self-care: coping under pressure and the ability to reflect in action
   - Manage an emergency situation; ability to work effectively in a team in an emergency situation including either leading or taking directions
   - Behave in a way that inspires confidence and reduces patient anxiety
Hauora Māori 
   - Ethnic disparities in food allergies and in allergy testing in New Zealand
   - Appropriate engagement and consultation with whānau
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Consideration of access to cultural/spiritual support for patient and whānau
Population Health 
   - Epidemiology of serious food allergy: time trends, risk factors, opportunities for prevention
Conditions to be considered relating to this scenario
Common
anaphylaxis, food allergy, foreign body, peritonsillar abscess/quinsy, trauma
Less common but 'important not to miss'
laryngeal squamous cell carcinoma, epiglottitis/supraglottitis, angioedema, vocal cord paralysis, smoke inhalation, Ludwig's angina
Uncommon
deep neck space infection, diphtheria