166. Peds upper airway obst. Flashcards
4 main groups of obstruction
o Acute infections
o Undiagnosed congenital abnormalities
o Congenital abnormality with an acute infection
o Foreign bodies
location of exp stridor
below glottis
location of insp/exp stridor
above or at glottis
15 causes of supraglottic obst
Congenital - Pierre Robin - micrognatia - Treacher collins - macroglossia - Down syndrome - storage disease - Choanal atresia - lingual thyroid - thyroglossal cyst Acquired - adenopathy - tonissilar hypertrophy - FB - pharyngeal abscess - epiglottitis Positional - micrgnathia
6 causes of glottic obstrcution
Congenital - laryngomalacia - vocal cord paralysis - laryngeal web - laryngocele Acquired - papillomas - FB
9 causes of subglottic obstruction
Congenital - subglottic stenosis - tracheomalacia - tracheal stenosis - vascular ring - hemangioma Acquired - croup - bacterial tracheitis - subglottic stenosis - FB
Presentation of choanal atreia
o Persistence of the membrane at posterior of nares
o Bilateral is emergency
o Unilateral may only present when have URI and obstruct other side
Definine retropharyngeal abscess and bacteria
- Infection of soft tissue space between wall and prevertebral fascia
- May be due to direct trauma (toothbrush) or nodes, or hematogenous
- Usually polymicrobial
- Strep most common
Sx of retropharyngeal abscess
o Fever, sore throat, neck stiffness, trismus, torticollis, stridor, muffled voice
o Won’t look side to side
xray findings of retropharyngeal abscess
Should not be more than vertebral body beside
Never more than 6-7mm at C2 level
May have air fluid levels
indications to drain retropharyngeal abscess
Scalloping of abscess wall
Rim enhancement
> 2cm
sensitivity of mono test
- IgM antibody test >90% sensitive in < 4yo
o 50% in older
major RO in mono
o Look for lymphadenopathy and splenomegaly
Need to RO lymphoma or may miss it!
mgmt mono
o Possible steroids and racemic epi
3 spaces of ludwig angina
sublingual
submandibular
submaxillary
MGMT ludwig angina
o Broad spectrum Abx with anerobic coverage
bacteria in epiglottitis
- H flu was most common, but now vaccine
o Strep and staph possible
Sx of epiglottitis
o Acute onset o High fever o Sore throat and toxic o Sniffing position o Drooling o Dyspnea, stridor, retraction, fever
3 signs on xray for epiglottitis
Thumbprint sign
Thickened folds
Air in vallecula
MGMT of epiglotitisi
o Secure airway
o If maintain airway, do not move to examine or xray
Quietly move to area where can intubate
o Adol. And adults can usually be observed in ICU
o If can’t bag or ETT, then cric
MGMT of laryngomalacia
Worse supine and with neck flexion
Rare to have significant resp distress
Better by 2yo
Sx of hemangioma
Stridor (bi) develops in first few weeks
Define laryngeal papillomas
Most common benign neoplasm
Vertical HPV from mother
Age range for croup
6-36 months
4 variables to assess when deciding on croup severity
- stridor at rest
- tachypnea
- restractions
- mental status
MGMT of croup
o Oral dex small dose is as effective as large dose 0.15mg/kg o Nebulized epi for stridor at rest Fast onset 1-2 hour duration o Possible evidence for heliox
Sx of bacterial tracheitis
Toxic child with high fever
Rapidly worsening stridor
Does not improve with epi
Sx may overlap with croup and epiglottitis
bacteria in bacterial tracheitis
Staph A + polymicrobial
MGMT FB in < 1yo
- 5 back blows
- Then 5 chest thrusts
- Head below trunk
- No blind sweep
MGMT FB in >1yo
• Heimlich if conscious
• Chest compressions if unconscious
If fails need advanced airway techniques
• Laryngoscopy and try to remove with magills
• If can’t see, intubate and try to push into mainstem
