Acute Upper Airway Obstruction

Question 1

Most common (MC) cause of stridor outside neonatal period (6 mos - 3 yrs)

Answer 1

Croup (viral laryngotracheobronchitis)

Question 1

Most common (MC) cause of stridor outside neonatal period (6 mos - 3 yrs)

Answer 1

Croup (viral laryngotracheobronchitis)

Question 2

Ety of croup

Answer 2

Parainfluenza virus

Rhinovirus

Question 3

Classic sx of croup

Answer 3

Harsh barking cough, hoarse voive, stridor often worse at night

Question 4

Sign of croup in CXR

Answer 4

Steeple sign: subglottic narrowing

Question 5

Tx of croup (3 meds & 1 procedure)

Answer 5

1. Nebulized epinephrine (1:1000) 0.5 mL/kg (max 5mL) to dec airway edema
2. Steroids:
   a. Dexamethasone 0.15-0.60 mg/kg PO/IM (max 10 mg)
   b. Nebulized budesonide 2 mg
3. Intubation

Question 6

Croup discharge criteria

Answer 6

No stridor at rest & 3h since last epinephrine
Normal color, O2sat & mental status
Able to tolerate oral fluids
Caretaker able to recognize worsening sx

Question 7

When to admit croup pt?

Answer 7

(+) Stridor at rest
(+) Tachypnea
(+) Retractions
(+) Hypoxia
(+) >2 epi doses

Question 8

Acute inflamm condition of epiglottis

Answer 8

Epiglottitis

Question 9

Common ety of epiglottitis

Answer 9

Strep and Staph spp (postvaccine era)

Haemophilus influenzae type B/ Hib (prevaccine era)

Question 10

Sx of epiglottitis

Answer 10

Drooling
Fever
Stridor
Sore throat

Question 11

Diagnostics for epiglottitis

Answer 11

Lateral neck radiography (thumb sign)

Laryngoscopy