34. Pediatric Airway Flashcards
Overgrowth of bony opening, noisy breathing worse with feeding and improving when crying, associated with central mega incisiors
Pyriform aperture stenosis
Obliteration or blockage of the posterior nasal aperture, unilateral or bilateral, stertor with unilateral discharge, noisy breathing, cyanosis with feeds, relief with cries
Chiamalo atresia
most common cause of ***
adenoid hypertrophy
14 year old M presents to your pediatric clinic with a cheif complain of sinus pressure runny nose, cough, congestion, fever. Mom reports he has had recurrent issues with sinuses since playinh hockey, prefers sleeping on his side - can be deviated septum or septal perforation, deviated septum involves trauma from delivery, sports, MVA, symptoms are preferring to sleep on one side, recurrent sinus infections, difficulty sleeping, worsened by age, allergies, and illness, treatment is with sinus repair, septal perforation can be due to trauma, wegerner’s granulomatosis, ***, treatment with surgical repair
nasopharynx case
18 month presents to pediatrician with runny nose and breathing problems, noisy breathing that has been getting worse since 4 days, breath is terrible - intranasal foreign body, associated wtih history of foreign body, unilateral mucopurulent nasal discharge, foul odor or halitosis, epistaxis, nasal obstruction, and mouth breathing, may remove with allgiator forceps or balloon catheter, most common item is paper, most dangerous item is button batteries
case II
extends from soft palate to hyoid, macroglossia, **, abscess, foreign body
oropharynx
can be due to tumors, hemagniomas, Beckwith-Wiedemann, hypothyroidism, Trisomy 21, present swith drooling, speech impairment, difficulty eating, stridor, and airway obstruction
macroglossia
acute, potentially life threatening syndome, caused by the sudden release of mast cell mediators into the systemic circulation, history of exposure to allergen, symptoms of nasal discharge, nasal congestion, sneezing, itching of the throat and ear canals, change in voice quality, sensation of throat closure or choking, stridor,
anaphylaxis
22 month old female presents to the ER with 2 days of fever, cough, shore throat, drooling, refusal to eat, stridor, she is febrile, tachycardic, tachypneic, and toxic appearing ***
oropharynx case
bacterial infection of the posterior oropharynx, occurs at age 206 years, ill apperance, fever, sore throat, stertor/stridor, muffled voice, trismus, bulging of the posterior wall of the oropharynx, diagnosed with contrast CT of the neck, admit for empiric IV antibiotics, stablize the patient/phlegmon/abscess <2.5 cm, ENT surgery consult due to unstable patient before imaging ***
retropharyngeal abscess
one of the suppurative complications of GAS pharyngitis but often polymicrobial, bacterial infection spreads beyond tonsil to neck and upper chest, AKA quinsy, more common in teens than younger kids, causes with fever, ill appearance, very sore throat, trismus, dysphagia, hot potato muffled voice, usually no stridor, unilateral erythema and bulging superior to the tonsil, uvula deviates away from the affected side, most managed as outpatients, drainage/aspiration in the emergency department, antibiotics, fluids/pain management, tonsillectomy at a later date may be recommended, complications are aspiration, airway obstruction, further dissemination of infection
peritonsillar abscess
typically food or household items, may get lodged in upper palate, tonsil, base of tongue or piriform fossaie, inability to swallow or handle secretions, treatment with forceps or endoscopic removal
oropharynx foreign body
extends from epiglottis to cricoid, continuation of the oropharynx and including the larynx and upper esophageal sphincter, glottis is the vocal cords, subglottis is below the vocal cords, ***
laryngopharynx
inflammation of the epiglottitis, most commonly caused by haemphilus influenza type B, presents with drooling, tripoding, difficulty breathing, ill appearance, stridor without cough, management is cautious, minimal intervention while making plans to secure airway in the OR, IV acess and imaging are deferred, antibiotics are indicated
epiglottitis
2 month old at your clinic for well child visit, noisy breathing with inspiration, present since birth and worse on feeds, soft inspiratory stridor
laryngopharynx case
congenital stridor, stridor caused by collapse of the supraglottic airway, felt to be due to neuromuscular airway dysfunction, often worse when eating or sleeping, worse when supine, improves when prone, can range from mild to severe, typically clinical diagnosis, most mild cases self-resolve in the first few years of life, children with moderate/severe or progressive stridor, apnea, or cyanotic episodes, or poor growth requires endoscopic examination ***
laryngomalacia
2 year old male presents to the ER at 3 AM, has had 2 days of runny nose and low grade fever with cough, cough is dry and harsh sounding, child has had a hoarse voice, child had worsening symptoms nad trouble breathing so dad rushed him in, on exam the child is non-toxic, tired, and has normal vital signs, clear runny nose ***
case III
typically parainfluenza, primarily affects ages 3 months-3 years, older kids have larger airways, harsh barky cough, sometimes inspiratory stridor, may have URI symptoms and fever, raspy or hoarse voice, classically worse at night, child goes to bed fine and wakes with frightening cough and wheeze, positive steeple sign, if no stridor at rest give single dose dexamethasone/decadron, if stridor at rest give dexmethasone and nebulized epinephrine, consider other diagnosis if using racemic epinephrine and isn’t working
viral croup
6 month old 27 week preemie male presents in clinic for well child, has had a hoarse cry since he was in the NICO, on exam is growing well, has normal vital signs, mild stridor at rest, and a weak, hoarse cry
case IV
accounts for 10% of congenital stridor, most often iatrogenic by intubation or idiopathy, may be neurologic so will need to evaluate foramen magnum for chiari malformation, presents as hoarseness, dysphonia, stridor, absent or weak cry, diagnosed with flexible nasolaryngoscopy, treatment with speech therapy, surgery, or injections ***
vocal cord paralysis
stenosis, cysts, webs, hemangiomas, papillomas
other subglottic pathology
narrowing of the airway below the vocal cords and above the trachea at the cricoid (narrowest part), 3rd most common cause of congenital ***
subglottic stenosis
presents with nosiy feeding and stridor, diagnosis with endoscopy, treatment with marsupialization
subglotting vallecular cysts
incomplete separation of the vocal cords, presents with respiratory distress, weak or high pitched cry, diagnosis with endoscopy
subglottic webs
