10. Stridor

Question 1

Ddx acute stridor in kids

4 day hx malaise, fevers cough

Answer 1

1. Acute Epiglottitis (HiB)
2. Croup (lanygotracheobronchitis)
3. Acute Tonsillitis
4. Acute Pharyngitis
5. Retropharyngeal Abscess
6. Diphtheria

Question 2

Airway interventions

Answer 2

Worsening airway obstruction

Evidence of deteriorating respiratory function
tachypneoa
accessory resp muscles
low sats despite supplemental O2
Agitation 2nd hypoxia

Question 3

Initial management

Initial assessment

Answer 3

Senior involvement
2 Anaesthetist / ENT consultant

Airway - Assess obstruction
-?intubate immediately

B - Signs resp distress / quiet breathing / not talking
-admin high fow o2
Spo2 monitor if not done

C - ?fluid status

Question 4

Initial Rx

Answer 4

Nebulised adrenaline
3-5ml 1:1000 Max 5mg
ECG monitoring

Avoid action upset and worsen obstruction
IV cannulation - ametop

transfer to OT appropriate monitoring and equipment

Question 5

Induction

Answer 5

Inhalation sitting upright
o2 & sevo
do it gradual
gradual change to supine
aim SV

low level CPAP ?improve obstruction

Ensure Depth prior to IV access and intubation
range ETT availlabe

IV secured - anti sialogogue
Atropine 20mcg/kg

Question 6

Intubation & post care

Answer 6

Intubate w/ ent on standby - failure secure
anatomy may be distorted

Intubation easy consider Oral to nasal switch - easier for PICU

Stable
Paralyse sedate & transfer to picu
CXR
NGT
IV Fluids
Blood Cx 
IV abx - guidelines