A fictional adult presents with fever, severe sore throat, muffled voice, drooling and increasing difficulty breathing.
Frame the danger first.
- Stridor, drooling, muffled voice, tripod positioning or rapidly worsening work of breathing may indicate threatened upper airway.
- A normal-looking mouth does not exclude serious supraglottic pathology.
- An agitated but oxygenating patient can deteriorate abruptly.
Act, escalate, reassess.
- Call anaesthetic, ENT and senior emergency support immediately through the local airway emergency pathway.
- Keep the patient upright, calm and continuously observed; avoid unnecessary examination or transport.
- Prepare a controlled airway plan in an appropriate setting with experienced clinicians.
- Use local antimicrobial and critical-care protocols after airway priorities are secured.
Red flags that change pace.
- Stridor, cyanosis, exhaustion, altered consciousness or rapidly worsening respiratory distress
- Drooling, inability to swallow secretions or marked voice change
- Haemodynamic instability or concern about a deep-neck-space infection
What makes care less safe.
- Forcing a tongue depressor examination
- Leaving the patient unattended while awaiting a test
- Attempting an unplanned airway intervention without senior expertise
Say the concern plainly.
Threatened upper airway: [stridor/drooling/voice/work of breathing], position and oxygenation [status], examination deliberately limited to [findings], and ENT/anaesthetic response [time/status].