Last updated on 24 Jul 2014 at 9:49 AM (ED01)

Compromised airway
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