Laryngospasms, lets talk complications in the PACU!
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- เผยแพร่เมื่อ 28 มิ.ย. 2024
- Today we will review laryngospasms, causes, complications, types, obstructive versus unobstructive and management of both types in the PACU. This video also discuss the Larson maneuver, racemic epinephrine, and positive pressure ventilation management.
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Thank you! Just moving into PACU and trying to learn all I can.
I just had my first instance of this about a month ago as an older adult. Woke up from a dead sleep with no idea what was going on. I thought I was dying. Took about 90 seconds and I was terrified.
I've had those spasms my whole life and they are horrific. Thank God I found that video last year that showed that Larson maneuver and it made all the difference in the world. I often wake up having such spasms and I try to remain calm, sit up, press behind the ears and hold my breath for 5 seconds and it stops it, but it's terrifying. I only wish I knew that technique decades ago. It's made all the difference in the world.
Hi Sharon, I'm sorry to hear about your struggle with laryngospasm, but am thankful that the Larson Maneuver is effective for you. You may want to be seen by and ENT to evaluate why you have recurrent spasms. Best of Luck to you! Cathy
I am in the same boat as you were. I wake up fully chocking and gasping for air - I wake up the whole house with my sound. It is terrifying to me and everyone who hears the noise.
When u say its and emergency, u mean it can be mortal? That's what we feel in the moment but apparently iy isn't?
@@sicoDelia An ENT is an ear, nose and throat specialist. You do feel like you might die for lack of getting air. You can breath out, but not in, it's terrifying. This technique has ended the terror since I learned it. I still wake up at time with acid washing up in my throat occasionally, but I just quickly sit up and press that spot behind my ears and hold my breath. It stops.
@@sicoDelia exactly ! Is it deadly or not ? So confusing ! Its terrifying but eventually it stops and you live ? Wth 🤦♀️😂🙄
Not talking about ER, hospital setting … we want ti know about when it happens at home
Thank you for this. I just started getting this after having Covid.
You're welcome, sorry you're experiencing this after covid. You may want to see an ENT if it is chronic in nature.
@@pacunursingminutes Yes! My GP referred me to one this week after I ended up in ER this weekend with nightly SOB. Thank you!
Im 72 I've had a total of 5 of these throughout my life over the last 5 years...I always get them after being in a deep sleep,wake up suddenly and start fighting for air,gasping for breath and fighting for my life...they leave me with a pounding fast heart rate and usually feel quite emotional after them.Ive read that losing weight helps a lot and sleeping with lots of pillows will help,Im going to practice the Larsons maneuver.Good Luck.
I'm crying just watching this video now I know what I have is something... ppl would not believe me had since I was little been getting a little worse lastima a couple second longer now I'm 24 thanks so much !!!!
Astrid, make sure you inform the anesthesia and pre-surgery team of this complication you have experienced for any subsequent surgeries. If its a chronic you may want to be seen by a good ENT in your region.
I'm 61 and I get laryngospasm all the time. Yes, it is terrifying. The inability to inhale and the sound is unreal. I've reconciled to the likelihood that I will die from this.
@@rrussell9731 You should seek professional consultation from an ENT. Don’t reconcile it is something that you should seek professional guidance on. Prayers to you R.
And what about fonoaudilogist, I heard they help training how to handle this. Ents and gastro don't believe me, im sick of doctors with no empathy and treat u like just like a nervous person
Been here five times ..from my childhood into adulthood but only when needing operations or procedures after waking up from general anaesthesia ..I have anxiety because of this and will opt local anaesthesia from now on. .
I couldn't even make that sound .
No air came in or out. I was panic stricken my eyes in tears...but I just sunk into blackness ..no point in even trying to breathe or struggle, I was at an acceptance of death being imminent.. I could only hope of fast speed oxygen pressure
So yeah I relied fully on medical staff .
But it's so stressful
I still have nightmares..
Corrienne, Thank You for sharing such a personal experience. The trauma of laryngospasms is profound, thankfully your complete obstruction was managed expediently with positive pressure ventilation. My heart goes out to you! It is stressful and scary that is why I created this educational video, to prepare teams to handle these difficult situations. Peace to you!
I had this during extubation felt I was going to die was given more propfol, sux and lma was re placed I have to get endoscopy soon and maybe a surgery and i think I'll die 😭
Thank you for doing the sounds. So helpful.
You’re welcome 😊
Thanks for spreading the knowledge! Great channel.
Thank You RN Scrub- you must be an OR RN! 🤣 Thanks for all that you Do!
@@pacunursingminutes lol. Close enough. ICU.
I am an Adult and I have had several severe Obstructive Laryngospasms, which were caused by the fumes of peppers, which needed several epi pens and 911. This video has given me some talking points to help me communicate with my Dr.
Thank You So Much!!
Your welcome! Glad to shed some light on this issue! Wish you all the best!
I'm 61 and have had laryngospasmfor about 10 to 15 years. My attacks are random but I'm pretty sure they are related to anxiety in some way. I'll usually get one or two a week, but sometimes I can go a month without having one. To say laryngospasm is frightening is the biggest understatement of all time. Why? Because you are aware that something has locked up your airway but there's nothing you can do about it. Most of mine slowly ease up after about 45 seconds and by about 3 minutes I'm breathing okay.
As an adult I have these spasms as do some family members. It’s terrifying! Panic sets in immediately. I can’t even think straight when it comes on. Usually it’s sudden and seemingly out of nowhere
Hi Marilyn, sorry to hear you suffer from laryngospasms, You may benefit from seeing an ENT, Ear Nose Throat Doctor who might be able to shed some light on your situation. Hugs to you!
You are describing what I have been experiencing for the past five years and have no idea what it is. I only know that it happens when I least suspect it. Maybe I cough to clear my throat and then there is no in breath. I simply can’t breathe. each time I am terrified and I feel like I’m going to die. and to the extent I can calm myself down then I eventually can breathe. it’s like my throat has just closed up and I’m taking an in breath through a teeny tiny hole. The only thing I know that precipitated this was an esophageal dilation. These episodes started soon after that. Understandingly I don’t want to go to the doctor for more intervention as I saw this ENT doctor because I had difficulty swallowing pills. it’s also noteworthy that I suffer from Gerd, silent reflux, LPR. Any advice from anyone would be greatly appreciated.
just saw your comment but my friend has the same thing and she was put on some meds by one of our ENT docs last year and she is having less episodes now . good luck
@@mcriquet Gerd definitely makes laryngospasms more likely as the acid can cause inflammation of the vocal cords and make them spasm much more easily. I have the same issue and when the Dr prescribed a Carafate, and super soothing medication for the GI tract, I finally started getting relief. As you know these episodes are terrifying and potentially dangerous. I found that trying to breathe slow and with my abdomen helps through the worst of it, when there is only a teeny tiny opening. I have this in response to any type of pepper being around me (esp on a pizza ) and have been to the ER many times. Breathing treatments help to relieve it. Sending you soo much love as this is a very difficult situation to deal with!!
Same here. I'm pretty sure mine are related in some way to anxiety, but they are so random it's hard to pinpoint the cause. They are ABSOLUTELY TERRIFYING.
I just need to say this, because it was terrifying. I get these from acid reflux. Normally, I can coach myself to be calm, and I can get through it. I've gotten accustomed to them, and they didn't really scare me anymore. Recently, it was paired with excessive phlegm in my throat at the time, so it was like 2 factors in one incident, and the closure went from bad to complete. I started to lose consciousness because it went on for so long. I wasn't just scared I was going to die - I actually almost did. It cleared spontaneously after over a minute. I was given a second chance and I'm not sure why, but I'm changing my diet to target the acid reflux. Hearing repeatedly in this video that this is an emergency issue really validates how I felt. When I read about it online, I keep reading that people don't die from it. From my own experience, I beg to differ. But in my instance, I doubt it would even be identified as cause of death, because the vocal cords would have relaxed by then. I imagine it would just look like choking on vomit / stomach acid, when really, it was a spasm.
You might get yourself checked for a Hiatal Hernia. Acid reflux is severe sometimes when you have this. I had one fixed and have not had any issues with acid at all...hope you find some answers...that would be terrifying!
@@SoulHavenPottery-gt2gf thank you so much! I've never heard of this, and I do resonate with one of the possible causes. I'll look into it!
@@LushQueenPersonal so weird you responded at this moment because I’m studying for a certification exam and just reading about a surgery for severe GERD that they do when nothing else has worked it’s called Nissen Fundoplication surgery. GERD is so bad for your esophagus, can cause erosion after awhile so I hope you get this treated somehow and don’t have to suffer with it
@@SoulHavenPottery-gt2gf thank you, and good luck on your exam!!
I’m so glad I found this channel. I plan on taking my certification. I need a review course though.
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I start having laryngeal spasms 5 years ago, after spinal fusion surgery and I agree it is scary, especially the first time. Over the years the have minimized in occurrence. My ENT has been so helpful. Wish I had of knew of this site years ago. Knowing about this technique now, hope it will bring more ease.
You're Welcome Jennifer!
I have had this problem for years and I hate it so much. I wish this can be surgically fixed. I am constantly trying to keep my airway open when I eat or sleep or just randomly out of nowhere my VCD will happen. I hate having to concentrate to just breathe. It happens to me way to often now. All my Drs ent thought it's something else. I take ppi's and ant acids I also stopped eating gluten which helped alot but still randomly get this happening to me. I feel that these Drs that I went to don't know crap. I want a Dr. that can actually help me get rid of this.
My Heart goes out to you- keep seeking to find a good ENT provider to help you.
Mine is caused by injury- chiropractor injured me & severe aerophagia & other injuries
Well done
I use to get this , strangled by a ghost , doc said don’t worry when you pass out and faint the spasm stops and you can breathe again . You can’t call for help , you drop to your knees . Turns out it FND symptom . Functional neurological disorder.
HI Tesla Thank You for watching! I hope you never have to experience this again. Thanks for sharing FND symptom I had not heard of this!
I’m on my last month of orientation on the PACU and just experienced this with a teenage patient. I’ll never forget the sound now.
Yes! Leaves a mark. Welcome to the PACU, I wish you the best in your career caring for patients. Glad your here learning more!
@@pacunursingminutes thank you for being a resource.PACU is really a hidden gem that covers so much.
@@KeyisKey_ when you’re ready check out the Certification review course!
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It's even scarier when the sound is coming from your own body. Terrifying doesn't even begin to describe the feeling. Its basically impending death. Fortunately mine mostly clear up in a minute or two and my normal breathing returns.
@@rrussell9731 I would be mortified. I am glad yours cleared up. That is scary.
Isn’t there a nerve on the side of the face - it was written about in the anesthesia journal in the 80’s - that can stop the spasm immediately. I suck like a straw with my lips while awake.
The vagus nerve innervates the glossopharyngeal nerve, this is the ninth cranial nerve, this may be the nerve your referring to? The Vagus also reaches to the pharynx, larynx esophagus, bronchi, lungs, heart, stomach, small intestines, liver, pancreas and kidneys! Busy nerve!!!!
Hi Cathy. I love all your videos and very informative. I am preparing for my PACU interview next few days. Any recommendation in terms of what I need to prepare/ learn?
Hi Jane, I wish you all the best with your interview. Emphasize teamwork, this is vital in the PACU and remember airway management is always number one! I’m sure you will do well, continue studying, find a few preceptors who will take you under their wing and mentor you. I hope this chapter in your career opens up and it brings many rewards!
I get these, maybe 10 times a year. The scariest thing in the world. You think you are going to die. It happens in the snap of a finger. Usually when I first consume something sweet. Or, in the middle of the night. Yikes.
Mike, with that kind of frequency you may benefit from seeing an ENT, Ear, Nose and Throat Doctor for evaluation.
@@pacunursingminutes How can you treat something that happens so little.
@@Mike45-47Q You may have an underlying cause that you are unaware of.
@@pacunursingminutes I do have a tonsil on one side larger than the other. Been like that as long as I can remember. Maybe...🤷
I have Laryngospasm, It's my right larynx that is paralyzed. I'm from Cape Town South Africa
Thanks for your comment. How did your Right larynx become paralyzed, if you don't mind sharing your story?
I have to check if you did one of these for adults. I have had attacks from drinking water to mucus after a tiny cough and even many own spit while sleeping. One lasted about ten minutes and was the most terrifying day of my life. My limbs went numb and I started to see white. I had an acoustic neuroma removed years ago. Could that have anything to do with this? I was told I have ‘silent GERD’ but the medications sent my LUPUS into overdrive. So, I changed my diet and that helps. Still, I am fearful of dental work being done, getting sick. One time at the emergency room years ago, they had just done a CT for kidney stones, and I had started to vomit and choked on it! Had a nurse not seen me choking, I wouldn’t be alive today. She had to do the Hymnic maneuver. Saved my life. Just wondering what else is out there on this. I feel like I have a ticking time-bomb and at any moment it would be my last.
Hi Grace, My heart goes out to you and this terrible health challenge. Thanks for sharing your story. Nurse Cathy
What if it closes completely? When this happens to me, there is zero air movement in or out to even make a sound.
HI Marleen, Then you have a complete obstruction which is a medical emergency (911), rescue maneuvers such as PPV, Positive Pressure Ventilation with an AMBU bag to PUSH OPEN the Vocal Cords or an Emergent Intubation with medications to relax the vocal cords or an emergent tracheotomy.
I had this during extubation felt I was going to die was given more propfol, sux and lma was re placed I have to get endoscopy soon and maybe a surgery and i think I'll die 😭
I can't find your video of the maneuver, tipping the link doesn't work
Search for "laryngospasm larson maneuver" there are several videos demonstrating it. Not sure which one this video was referencing.
Check this simple video from NEJM, th-cam.com/video/y5zxJL1eUHY/w-d-xo.html
A routine thing if I have an upper respiratory infection. Not pleasant.
Hi Michael, Thank You for the comment! It may be of benefit to see an ENT Dr to help identify why this is a recurrence for you with URI. All the best to you!
@@pacunursingminutes thank you for the good advice. I’ve always just accepted it. Time to seek some care.
I had this once after surgery so I’m told by the anesthesiologist. They told me it was touch and go. 😮
I had this during extubation felt I was going to die was given more propfol sux and lma was re placed I have to get endoscopy soon and maybe a surgery and i think I'll die 😭
@@melissabrill8367 oh wowww! I feel you that’s scary. I would be terrified too. I wish you good luck with your procedures. 🥺🤗
@@andreahickman you had a similar experience? It is very scary but I think they are more common than we think
@andreahickman 87 people per 1000 have one during surgery I just read.
@@melissabrill8367 Well I was told that when they was taking the tube out I had a laryngospasm. I was told by the anesthesiologist that I had a laryngospasm and it was touch and go. I don’t remember it nor what happened so I don’t know what they did to fix it. The anesthesiologist said I have to inform anesthesia staff if I have any surgeries. This happened in the 97.
If my patient has his/her LMA tube insitu postop going to PACU for monitoring and recovery and started having laryngospasm, do i have to remove the LMA and start ventilating using ambu bag with100%O2 or keep the LMA insitu and bag from there via LMA??
Hi Faith!
Excellent Question! I honestly have never had it happen with an LMA only after removal of OA's upon awakening in pediatrics. I have asked a few anesthesia providers for their feedback and you should ask those whom you work with. The current algorithm for management is to identify laryngospasm, remove stimulus(secretions), open airway (jaw thrust, chin lift, neck extension and /or OA), 100% Fio2 via PPV, Larson Maneuver and evaluate if partial or complete obstruction of airflow. The PPV can be provided via Mask, Supraglottic airway (LMA/igel) or ETT . Great Question!
I had this during extubation felt I was going to die was given more propfol, sux and lma was re placed I have to get endoscopy soon and maybe a surgery and i think I'll die 😭
I have heard, that if you can't breathe, you can faint and once you faint, all muscles relax immediately - leading to the spasm to go away. Can somebody confirm?
I have been having this also from childhood until well, just half an hour ago. It's always the worst! (just got over a covid, still coughing, obviously thats irritating the larynx..?!) Anyway, I found a lot of info online after so man years and the pressure point seems to help, also I read once, a person was saying cold air, like sticking your head into the freezer, helps also relax muscle. Taking magnesium helps... and I have head it overnight, and afterwards there seems to remain a small pain on the spot. Usually with me it's on my rather right side of the throat.
Hi Bgrose78,
Sorry you battle laryngospasm, I would recommend you find an ENT you like and get evaluated, it should not be a chronic problem. Yes once you relax the vocal cords it will open, anesthesia administers medications to reverse the closure. All the Best to you! Cathy
@@pacunursingminutesis there a permanent solution for laryngospasms
I have had three laryngospasms and I was terrified as I thought I was going to die. Could vomiting bring on an attack as it feels like acid in the throat doesnt help. If you were vomiting and it happened you would surely choke on vomit as it couldnt come up? This terrifies me.
Linda, it would be wise to be evaluated by an ENT if this is a frequent occurrence for you. Secretions can and do trigger laryngospasm. You may need to be evaluated for any anatomical abnormality.
I did a chest X-ray but they said nothing is there. But I keep making this weird, loud and embarrassing noise when air forcefully comes out from my chest and it’s as if my throat is suddenly close when I want to exhale and this gives me a very sharp pain on my chest. I’m not really sure where. But it gives me this sharp pain on my chest when it happens and I do that like 20times a day🥺 the dr.s keep saying nothing is wrong with my chest. What can I do🙏
My friends had to call 911 few days ago.
The nurse even said I’m faking it.
Hi Joke, you should see an ENT/pulmonary specialist to help identify your problem. All the best to you!
@@pacunursingminutes thank you
I had my 1st spasm this week. I honestly thought I was going to die. Terrifying!!!
Hi Janet, That is terrifying, I'm glad your OK! IF it continues you should seek advice from a good ENT!
My first was today! 62 years old, "Healthy as a horse." then boom! Just sitting in my truck, not driving, not drinking or eating..just sitting.
@@pacunursingminutes thank you! Will do.
@suzanberaza1120 oh Susan, my heart goes out to you. It's truly terrifying. I hope you're ok xx
@@janetDT1904 Hi Janet, it's actually my husband.. He was logged in to my account and looking for answers.. so it showed up as me. But yes it was HORRIBLE.. but now at least we know that... normally, it is the brains self protect mechanism and that it SHOULD be ok.. from staying calm, breathing slowly, etc.
I had one yesterday after water went down the wrong pipe. I couldn't breathe for minutes and it felt like I was suffocating. Is it normal to have this after drinks or food going down the wrong pipe?
Hi Cierra, you triggered a spasm from the fluids irritating your larynx is my guess. Glad your ok! Yes, fluid and blood or food can trigger vocal cord irritation and partial and complete closure of the cords.
@@pacunursingminutes or i think Is panic that clóse More
Yes it happens because of this to me. Food or water or reflux fluid entering the wrong pipe triggers it.
For 25 years I've had frequent "liquids going down the wrong pipe" yes, it causes a reaction where the throat closes.. I'm assuming the brain is attempting to prevent more liquid from going down... BUT this is different! Today, at 62 years old I had my first ever 'throat closure'... but I was not drinking or eating or exercising or talking!!!! Just sitting on a chair and BOOM.. couldn't breath for 30 seconds...
hi can i ask that laryngospasm can make u die?because i have gerd and choking and cant breath plus make me panic...so can i go to clinic rn?
Hi Ruthchel, Thank you for your comment, laryngospasms are scary and can be life threatening. I recommend you get a physician expert to evaluate your situation. Ideally an ENT, Ear, Nose and Throat Doctor should be able to identify why your having difficulty with your GERD. I wish you the best!
@@pacunursingminutes
Why are you telling people that this can be life threatening?
@@monebone6326 because it can…
@@akashajoti6456
Oh and that's why all my doctors are telling me it's not.
As to my knowledge No. It will not kill you although it is very scary
One side of my voice box is paralyzed
Thanks for your comment. I'm sorry you have this health challenge. Hugs to YOU!
Im 71 and I have Laryngospasm, one side of my voice box is paralysed. DO NOT BEND YOUR NECK
Do not bend your neck forward when eating especially, that can start laryngospasm
I start awake, feel like i take half a breath then go into full panic trying to breath. Sometimes i urinate thinking im going to pass out. I am constantly scared of it happening. I have learned to calm myself down and get over it but its THE WORST!!!
Hi Dentage, you may want to seek out a good ENT to help you!
@@pacunursingminutes All good, giving up smoking has pretty well stopped it, happy days!!
@@TheDENTAGE Good For YOU!!!!!!!!! That Is HARD! CONGRATULATIONS!