Airway Flashcards by Kasia Lenz

Features of supraglottic stridor: sound/structures/congenital and acquired causes

Sonorous / snoring
Gurgling
“Hot potato” voice
Expiratory stridor

Nose
Pharynx
Epiglottis

Micrognathia
Pierre Robin
Treacher Collins
Macroglossia
Down syndrome
Glycogen storage disease
Choanal atresia
Lingual thyroid
Thyroglossal duct cyst

Adenopathy
Tonsillar hypertrophy
Foreign body
Pharyngeal abscess Epiglottitis

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Features of glottic stridor: sound/structures/congenital and acquired causes

Biphasic stridor

Larynx
Vocal cords

Laryngomalacia
Vocal cord paralysis
Laryngeal web
Laryngeal papilloma

Papillomas
Foreign body

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Features of suglottic stridor: sound/structures/congenital and acquired causes

High Pitched inspiratory stridor

Subglottic trachea

Subglottic stenosis
Tracheomalacia
Tracheal stenosis
Vascular ring
Hemangioma cyst

Croup
Bacterial tracheitis
Subglottic stenosis
Foreign body

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Define the retropharyngeal space

Potential space between the posterior pharyngeal wall and prevertebral fascia from the base of the skull to T2
Rich in lymph tissue, drains the nose, pharynx, sinuses and ears.

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List the clinical features of retropharyngeal abscess

fever
nuchal rigidity
reluctance to turn head from side to side
reluctance to extend neck
torticollis
trismus
neck swelling
drooling
stridor
muffled voice

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list false positives for widened prevertebral soft tissue space

neck in flexion

x ray in expiration

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List bacteria that cause epiglottitis

HIb
GAS
S. aureus
Strep pneumonia
(can also be non-infectious from swallowing hot liuquids)

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What abx should be used to treat epiglottitis

cefotaxime 50mg/kg q8hr

2nd or 3rd gen cephalosporin

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In children, how do unilateral and bilateral cord paralysis differ clinically?

Unilateral:
o Related to traction of Lt recurrent laryngeal nerve during birth or compression from mediastinal structures
o Coarse, weak cry
o Stridor worsens with distress and improves with positioning of the affected side down
Bilateral:
o Associated with serious CNS abnormalities like the Arnold-Chiari malformation
o Results in severe respiratory distress

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What causes laryngeal papillomas?

Perinatal or postnatal exposure to HPV

Stridor and obstruction by age 3-4

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List causes of subglottic narrowing or stenosis

Subglottic trachea is the narrowest part of the pediatric airway, completely surrounded by cricoid ring à predisposes it to obstruction
Congenital laryngotracheal “subglottic” stenosis
Acquired subglottic stenosis (prolonged intubation, trauma)
Subglottic hemangioma
Inflammation (Croup)

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what are the complications of RPA

sepsis
aspiration pneumonia
mediastinitis
empyema
airway obstruction

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what are the viral causes of croup

parainfluenza type 1 (most common)
parainfluenza 2 and 3
RSV
influenza A and B
Rhinovirus
adenovirus

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List 7 signs used to evaluate severity of croup

stridor
WOB
HR
mental status
air movement
RR
cyanosis

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List indications to admit child with croup

severe resp distress or failure
persistence of stridot at rest after aerosolised epi and steroids
persisitence of tachycardia and tachypnea
dehydration
unusual sx (hypoxia, hyperpyrexia)
complex PHx

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what age group is affected by bacterial tracheitis

3-4y.o. MC s. aureus or polymicrobial

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what is the mgmt of bacterial tracheitis

intubation in controlled setting
abx: clindamycin + cefotaxime
bronchoscopy emergently

what are the complications of bacterial tracheitis

TSS
septic shock
renal failure
post intubation pulmonary edema
ARDS
need for reintubation

Define asthma

a lower airway dz marked by chronic inflammation, and hypersensitivity with variable, reversible bronchoconstrictio. Characterised by episodes of wheezing, breathlessness, chest tightness and coughing.

what causes children to be more susceptible to worse outcomes?

decreased airway diameter
more reliance on diaphragm
smaller airways
higher metabolic rate and O2 consumption

ist risk factors for death from asthma.

Asthma Hx:
o Previous severe exacerbation (ICU or intubation)
o >2 hospital admission for asthma last year
o >3 ED visits for asthma in last year
o Hospitalization or ED visit for asthma past month
o Using > 2 canisters SABA per month
o Difficulty perceiving asthma Sx or severity of exacerbations
Social Hx:
o Low SES / inner city
o Illicit drug use
Comorbidities:
o Cardiovascular disease
o Other chronic lung Sz
o Chronic psychiatric disease

when can PEF be used in asthma

age 7 and up

define mild, moderate and severe asthma based on PEF

mild GT 70%
moderate 40-70%
severe LT 40

define bronchioloitis

an acute infectious disease that results in inflammation of small airways in children LT 2y.o.
manifests with wheezing, hypoxia and increased WOB with S/z of URTI

what are RF for RSV bronchiolotis

``` daycare school-aged siblings crowded living conditions second-hand smoke multiple birth cohorts prematurity undereducated caregivers ```

differentiate anaphylaxis from anaphylactoid reaction

- Anaphylaxis: o Immediate type 1 hypersensitivity reaction o Requires previous sensitization o Re-exposure produces antigen-cell surface IgE interaction o Mast cell and basophil degranulation o Histamine release (and tryptases, cytokines, prostaglandins, platelet activating factor) - Anaphylactoid: o More common o Does not require previous sensitization o Mediator release in cause by: § Direct action on mast cells and basophils § Disruption of arachadonic acid metabolism pathway § Immune complex mediated activation of complement pathways

List bacterial causes of pneumonia (usual first then less usual).

``` - LT 3 months o Group B strep o Gram negative bacilli o Listeria o Ureaplasma urealyticum - GT 3 months: o Streptococcus pneumonia o Haemophilus influenzae o Staphylococcus aureas o Group A streptococcus o Neisseria menigitidis o Anaerobic bacterias (aspiration associated) o Psuedomonas aeruginosa o Legionalla pneumophilia o Pneumocystis carinii o Rickettsial ```

List viral causes of pneumonia.

``` - Neonatal: o Rubella o CMV o HSV - Most common ```

List causes of altered protection against infection that place children at increased risk of acquiring pneumonia.

``` - Congenital anatomic abnormalities o Cleft palate o Tracheoesophageal fistula o Pulmonary sequestration - Immune deficiencies - Neurologic alterations increasing predisposition to aspiration o Coma o Seizures o CP o General anesthesia - Changes in quality of secreted mucus o CF ```

List complications of bacterial pneumonia (i.e. S pneumonia or S. Aureus).

1. empyema 2. pleural effusion 3. lung absess 4. pneumatocele 5. necrotising pneumonia 6. hypoxia 7. respiratory failure 8. multi organ failure 9. dehydration

| What physical exam finding of the head and neck may or may not be associated with Mycoplasma as a cause of pneumonia?

bullous myringitis

List complications of mycoplasma pneumoniae

1. hemolytic anemia 2. myopericarditis 3. neuro a. meningoencephalitis b. GBS c. transverse myelitis d. cranial neuropathy 4. arthritis 5. Rash: erythema multiforme

Admission criteria for pediatric pneumonia:

- Toxic appearance - Vomiting/dehydration - Respiratory compromise - Immunocompromised - Multilobular disease - Suspected pertussis

what cause of pneumonia should you consider in infants 3-19 wks of age and how does it present?

Chlamydia trachomatis: -conjunctivitis (preceeds resp sx in 50%) -can resemble paroxysms of pertussis -middle ear abN in 50% CXR: bilateral symmetric interstitial infiltrates, hyperinflation

Describe the 3 clinical stages of pertussis

1. Catarrhal (think katar): mild URTI sx x 1-2wks 2. Paroxysmal stage severe paroxysms of staccato cough followed by post tussive emesis (+/- cyanosis and apnea in infants) 2-4 wks 3. Convalescent stage: gradual waning of Sx

How is pertussis treated

0-6mo admission for apnea monitoring + macrolide | all others: macrolide or septra

Provide list of noninfectious causes that present as pneumonia on CXR

``` Radiologic technique: inadequate inspiration breast shadow thymus uneven grid on film underpenetrated film ``` ``` Primary pulmonary asthma bronchiolitis atelectasis bronchopulm dysplasia CF pulmonary sequestreation congenital cystic adenomatoid malformation alpha 1 antitrypsin def ``` Aspiration: FB chemical recurrent Primary cardiac: CHD CHF Pulmonary infarction sickle cell vaso-occlusive crisis PE Collagen vascular d/o ARDS Pleural effusion Neoplasm

What is CF

autosomal recessive dz caused by mutation in CF gene | 1/25 caucasians is a carrier

What makes patients with CF uniquely sensitive to bacterial infection of the airway?

- Defects in chloride transport across airway epithelium result in: o Reduced cilliary clearance of thickened mucous o Decreased antimicrobial affect of airway surface o Increased bacterial adherence o Innate secretion of inflammatory cytokines

What is the other name for Chronic Lung Disease (COPD of infants).

- Bronchopulmonary dysplasia | 40% with BW LT 1000g