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Airway Obstruction — SCE Medical Oncology MCQ

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HardOncological EmergenciesAirway ObstructionSCE Medical Oncology

A 65-year-old man presents with acute stridor and respiratory distress. He has a known mediastinal mass from metastatic lung cancer. SpO2 is 88% on high-flow oxygen. He is sitting upright. What is the emergency management?

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Correct answer: A — IV dexamethasone 8 mg, heliox if available, urgent senior anaesthetic/ENT assessment for airway management, consider emergency radiotherapy or stenting

Acute upper airway obstruction from mediastinal/tracheal tumour compression is a life-threatening emergency. Immediate management includes: keep the patient upright, IV dexamethasone (to reduce oedema), heliox (helium-oxygen mixture to reduce turbulent airflow), urgent senior anaesthetic/ENT input for airway assessment (possible awake fibreoptic intubation or emergency tracheostomy), and consideration of emergency airway stenting or single-fraction radiotherapy. Lying the patient flat may worsen obstruction.

Reference: ESMO 2024 Oncological Emergencies; NICE NG122; Difficult Airway Society Guidelines