Apex- Peds Flashcards
Compared to epiglottitis, which findings are MORE likely to occur with laryngotracheobronchitis? (select 3)
-age < 2yo usually affected
-high fver
-tripod position
-steeple sign
-onset 24- 72hrs
-more likely to require anesthesia for urgent airway control
- age < 2
- onset 24-72hrs
- steeple sign
Generally speaking, what is usually bacterial vs viral:
epiglottitis (supraglottisis) or laryngotracheobronchitis (croup)
Epiglottis - bacterial (worse)
laryngotracheobronchitis - viral (usually)
Age affected of epiglottitis (supraglottis) vs laryngotracheobronchitis (croup)
epi = 2-6
laryngotracheobronchtiis (croup) < 2yo
onset of epiglottitis vs laryngotracheobronchitis
epi < 24hrs - rapid (bacterial)
laryngotracheobronchitis - gradual (24-72hr) (viral)
region affected in epiglottitis vs laryngotracheobronchitis
epiglottitis - supraglottic structures (above the cords- epiglottis, vallecula, aretenoids, aryepiglottic folds)
croup - laryngeal structures below the vocal cords
What is Thumb’s sign indicitative of?
what kind of xray?
swollen epiglottis (epiglottitis/supraglottitis)
lateral xray
What is Steeple sign indicitave of?
what kind of xray?
subglottic narrowing seen in laryngotracheobronchitis (croup)
frontal xray
T/F - tripod position helps breathing with croup
false - epiglottitis
maybe changes upper airway resistance? idk
think epiglottitis is 2-6yo - they are the ones who can prob assume this position anyway
Which one has a high grade vs low grade fever
epiglottitis vs croup
high grade - epi (bacterial, fast onset, worse)
low grade - croup (more gradual onset, younger)
What are the 4 D’s apart of ?
Epiglottis
Drooling
Dyspnea
Dysphonia
Dysphagia
clinical presentation of croup (5)
Low-grade fever
Inspiratory stidor
Vocal hoarseness
Barking cough
Rectractions - suprasternal, substernal, intercostal
LIVBR
Treatment for epiglottitis
vs treatment for croup
o2
urgent airway management
ENT surgeon must be present
-tracheal lintubation vs tracheostomy
-induction with spontaenous RR –> CPAP 10-15cm H20 prevents airway collapse
-abx and postop ICU care
humidified o2
racemic epi
corticosteroids
IVF
-intubation rarely required
When diluted into 2.5mL of 0.9% sodium chloride, what is the MOST appropriate dose of racemic epi to administer to a 30kg child with post-intubation croup?
A. 0.5mL of a 0.25% soluation
B. 0.5 mL of a 2.25% soluation
C. 5mL of a 0.25% soluation
D. 5mL of a 2.25% soluation
B. 0.5ml of a 2.25% solution
0-20kg = 0.25mLs
20-40kg = 0.5mL
>40kg = 0.75mL
Airleak should be less than what to decrease risk of postintubation laryngeal edema
<25cm H20
(tracheal perfusion pressure is 25cm h20, any pressure greater than this reduces tracheal perfusion > edema > reduced supglottic airway diameter > increased wob)
Most common risk factor for postintubation laryngeal edema
using too large of an ETT
maybe this is why matt always uses 7.5 for guys
Why do u want to be careful not to use too big of an ett?
post-intubation laryngeal edema
What 5 things can increase the risk for postintubation laryngeal edema?
-using ETT thats too big (most common)
-cuff pressure to ohigh
-trauma from multiple attempts
-prolonged intubation
-age <4 (more common in small kids)
someone has postintubation larygneal edema- now what?
cool and humidified o2
dexamethasone
and racemic epi (weight dependent)
s/s of post intubation croup
when does it typically occur?
hoarseness
barky cough
stridor
30-60 mins following extubation
T/F- trisomy 21 increase risk of post intubation croup
true
How many mLs of what % Racemic epi solution for:
0-20kg
20-40kg
> 40kg
what are you diluting it with and how much?
2.25% racemic epi
0-20kg: 0.25mL
20-40kg: 0.5mL
>40kg: 0.75mL
dilute with 2.5mL of NSS (each dose)
How much decadron would you give for post-intubation croup
how long does it take to achieve the max effect?
0.25-0.5mg/kg IV
4-6hrs
what is heliox?
how does it work?
when would you use it?
mixture of helium and o2
improves laminar airflow by reducing reynolds number
croup
t/f: antibiotics are indicated for post-intubation croup
false
unlike laryngotracheobronchitis (infecious coup); post intubation croup is not infectious
how long should patients be aboverved for after racemic epi tx is complete?
minimum of 4 hours
What age is postintubation laryngeal edema most often seen?
<4yo
How long do most clinicians postpone a procedure for kids with an active URI
why
2-4 weeks after onset of symptoms
active or recent hx increases risk of pulm complications
When would you cancel a snotty kid? (6)
- purulent nasal discharge
- temp > 38
- lethargy
- persistent cough
- poor appetite
- wheezing and rales that don’t clear with cough
if you have to use an ETT in a kid with a recent URI, how should you proceed?
use a smaller size than normal
t/f - pretreating a kid with a recent URI with inhaled bronchodilator or glyco does NOT provide a clear benefit
True
What is the best volatile agent for a kid with a recent URI?
SEVO
How long can the risk of pulmonary complications persist for after the onset of URI symptoms
6-8 weeks but clinicans will wait 2-4
T/F- a snotty kid that was a previous preemie is reason enough to cancel an elective case
true
or <1yo
Mechanical irritation (ETT use) increases the risk of bronchospasm by how much in snotty kids?
10 fold
snotty kids that are cleared for surgery- considerations
5
use least irritating airway
if ett is needed, downsize
decadron 0.25-0.5mg/kg to reduce risk of post-intubation croup
ensure deep lane of anesthesia before instrumenting airway
sevo
a 3yo kid aspirated a peanut and comes in for rigid bronchoscopy. What is the MOST important anesthetic consideration for this patient?
A. inhalational induction
B. observing NPO guidelines
C. Positive pressure ventilation
D. Rocuronium
A. inhalational induction
*goals = prevening complete airway obstruction and preventing it from moving distally in the airway (which PPV would do)
Classic triad of foreign body aspiration
cough
wheezing
decreased breath sounds on affected side (usually right)
in kids with a foreign body aspiration, what would stridor vs wheezing indicate?
stridor = supraglottic obstruction
wheezing = subglottic obstruction
gold standard procedure to retrieve foreign body from the airway?
rigid bronchoscopy
Best maintenance technique for foreign body aspiration removal with rigid bronch
anesthesia
TIVA
What condition
Pierre Robin
- small/underdeveloped mandible
- a tongue that falls back and downward (glossoptosis)
- cleft palate
- neonates often require intubation
what condition?
4 things associated with it
Treacher collins
- small mouth
- small/under developed manidble
- (small) nasal passages - blocked by tissue (choanal atresia)
- ocular and auricular anomalies
