Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENT Secrets > Chapter 47 - Acute Pediatric Airway > Flashcards

Chapter 47 - Acute Pediatric Airway Flashcards

1
Q

What causes stridor? (physiologically)

A

turbulent airflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does pt having a syndrome affect your assessment of their airway?

A

Syndromic patients w/ mandibular hypoplasia more likely to have multilevel collapse/obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What condition do you think of when you see respiratory distress with inspiratory or biphasic stridor in setting of strong cry

A

bilateral TVC paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How much smaller is infant larynx compared to adult? Average diameter of subglottis in infant

A

1/3

3.5mm subglottis, adult is 10-14mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cervical level where larynx is located in infant vs adult

A

Infant: C2-3
Allows supraglottic structures to interdigitate with soft palate to optimize airway for suck-swallow-breathe
Adult: C7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does chest wall compliance affect neonatal respiratory distress

A

Greater compliance –> easier collapse –> quicker O2 desats, higher O2 consumption at baseline, smaller lung capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How poisuelle’s law affects neonatal respiratory distress

A

resistance inversely proportional to radius^4

1mm obstruction (edema) in infant subglottis (which is 1/2 of the radius) leads to 16-fold increase in resistance, 75% decrease in airway cross-section

1mm obstruction in adult subglottis (r = 6) would decrease cross section area by 30% and increase resistance by 2x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to tell if inspiratory stridor is at level of VC or above

A

at VC: high pitched

above VC: lower pitched (may be stertor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Expiratory stridor

A

distal trachea/bronchi
more prolonged, sonorous sound
prolongs expiratory phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Biphasic stridor

A

fixed lesion, usually subglottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs of impending respiratory failure

A

biphasic stridor or quiet breathing after prolonged stridor, suprasternal/subcostal retractions, accessory mm use, nasal flaring, diaphoresis, AMS, neck hyperextension/tripod (lean forward/chin up/mouth open/brace hands), tachypnea, tachycardia, pallor and cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does O2 desaturation tell you about severity of respiratory distress

A

ominous sign
because tachypnea and tachycardia can compensate and keep O2 up, the O2 going down indicates impending decompensation frequently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of neonatal airway obstruction at birth: Nose

A

rhinitis, piriform aperture stenosis, NLD cyst, nasal mass, choanal atresia, encephalocele, midface hypoplasia (Downs, Crouzon)

Nasal obstruction leads to respiratory distress relieved by crying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of neonatal airway obstruction at birth: OC/OP

A

Micrognathia (Pierre Robin, Treacher-Collins), macroglossia (Downs), lingual thyroid, mass/cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of neonatal airway obstruction at birth: Larynx

A

laryngomalacia, VC paralysis, subglottic stenosis, web, atresia, cyst/mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of neonatal airway obstruction at birth: trachea

A

tracheobronchomalacia, stenosis/atresia, extrinsic compression (vascular ring, double aortic arch, pulmonary artery sling), complete tracheal rings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Until what age are neonates obligate nasal breathers?

A

4-6 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Choanal atresia: definition, embryology

A

Posterior nasal cavity doesn’t communicate with NP

Failure of nasobuccal membrane to rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Choanal atresia: Unilateral vs Bilateral

A

2/3 unilat, usually present later with rhinorrhea, chronic congestion

1/3 bilateral, present neonatal period with cyanosis during feeding relieved by crying, 50-75% have associated congenital anomaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diagnosis of choanal atresia

A

Failure to pass catheter through nose

confirm with endoscopy, CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CHARGE

A 
Coloboma
Heart
Atresia choanae
Retardation
Genitourinary disorder
Ear anomaly/hearing loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Robin sequence

A

Glossoptosis and retrognathia –> BOT obstruction

Micrognathia and glossoptosis –> prevent fusion of palatal shelves at midline –> U-shaped cleft palate

23
Q

Syndromes with Robin sequence

A

Treacher Collins, Stickler, velocardiofacial

24
Q

How to Tx Robin sequence

A

Evaluate with laryngobronchoscopy/sleep endoscopy/PSG
O2, prone position, nasopharyngeal trumpet, CPAP

If FTT, OSA, respiratory failure –> escalate

Surgery: tongue-lip adhesion, mandibular distraction, tracheostomy

25
Q

Laryngomalacia: what it is, anatomic causes

A

collapse of supraglottic larynx –> inspiratory stridor

may result from aryepiglottic fold shortening, redundant supraglottic tissue, hypotonia

26
Q

Cause of bilateral VC paralysis

A

Idiopathic 46%

Arnold Chiari, CP, hydrocephalus, spina bifida, birth trauma, hypoxia

27
Q

Workup of bilateral VC paralysis

A

MRI
genetics
laryngoscopy and palpate cricoarytenoid joint (delineate VC paralysis from joint fixation)

28
Q

Treatment and prognosis of bilateral VC paralysis

A

tracheotomy

recovery in time usually with idiopathic cases

29
Q

Epiglottitis: age, onset, prodrome, temp, sx, pathogens, xr

A 
2-7 yo
Rapid onset
No prodrome or mild URI
High fever
Muffled voice, speech limited (pain)
Late inspiratory stridor, none at first
No cough
Odynophagia/drool
Toxic appearing
H Flu B, GABHS (S Pyogenes)
Thumb print sign lateral XR (thick/round epiglottis, lose normal vallecula air space
30
Q

Laryngitis

A

Any age, slow onset, URI prodrome, no fever
hoarse, no stridor, variable cough, no odynophagia/drool
Non-toxic
virus

31
Q

Croup

A 
6mo-3yr
Slow onset, URI progrome
No fever or low grade
Hoarse, inspiratory stridor (progress to biphasic if severe), barky cough, no odynophagia/drool
Non-toxic
PIV
RSV
Steeple sign (narrow subglottis)
32
Q

Tracheitis (bacterial)

A

6mo-8yr
Rapid onset, URI progrome
High fever
Hoarse, biphasic stridor, barky cough, no odynophagia/drool
Toxic appearance
S Aureus, M Catarrhalis
XR- normal epiglottis, tracheal lumen obscured by sloughed mucosa…called “pseudomembranes”

33
Q

How to differentiate epiglottitis from tracheitis: age, sx

A 
Epiglottitis younger (6mo-3yr), tracheitis 6mo-8yr
Epi has no prodrome, no hoarseness, no stridor, no cough
Trach has prodrome, hoarseness, biphasic stridor, barky cough
Both are rapid onset, high fever, toxic-appearing
34
Q

Why is the name epiglottitis not really correct?

A

Typically involves entire supraglottis

35
Q

When did HIB vaccine get implemented?

A

1988

36
Q

Management of supraglottitis

A

If stridor/respiratory distress –> may have impending need for surgery
Close airway surveillance, ABx IV, 10-14d course
If operation necessary: DL w/ ET tube or trach
Usually extubate within 48 hr when edema improves and air leak present around ETT

37
Q

Management of croup

A

Supportive care
85-99% outpatient
Steroids if significant sx (1 dose dex), race epi
If inpatient –> repeated dex/race epi until resolve
1-5% require intubation

38
Q

When to DL patients with croup

A

very young

severe or recurrent to r/o underlying pathology (subglottic stenosis, hemangioma, subglottic cyst)

39
Q

Tx bacterial tracheitis

A 
not as severe as epiglottitis usually
rigid bronch, debridement
60-80% require intubation
extubation after fever resolves, secretions diminish, air leak present
IV ABx, 10-14d course
40
Q

Presentation of PTA vs RPA/PPA

A

PTA: hot potato voice, stertor, milder airway sx (obst at OP)

RPA/PPA: fever, sore throat, dysphagia, decreased neck mobility, more likely to have airway obstruction (es with RPA)

41
Q

Why are 1-3 yo more prone to FB aspiration?

A 
explore with mouths
poor swallowing coordination
lack posterior dentition necessary for chewing properly
lack appreciation of what is edible
likely to be playing when eating
42
Q

Items most likely to be aspirated

A

incompletely chewed food - nuts, seeds, beans

toys

43
Q

Most common esophageal FB

A

coins

44
Q

Sx of FB aspiration: Larynx

A

cough, hoarse, obstruction –> edema

45
Q

Sx of FB aspiration: trachea

A

stridor, wheeze, dyspnea, coughing

No hoarseness!

46
Q

Sx of FB aspiration: bronchi

A

most common location 80-90%

cough, wheeze, decreased unilateral breath sounds

47
Q

Sx of FB: esophagus

A

dysphagia, odynophagia, drool, vomit
more common than airway FB
cricopharyngeus, where esophagus crosses aortic arch

48
Q

x-ray to get for FB

A

inspiratory and expiratory XR
FB may allow air to enter but not escape –> trapping/hyperinflation exaggerated by expiratory phase
atelectasis, pneumonia

49
Q

How many FB pts have NL XRs?

A

25-50%

50
Q

How to manage FB aspiration

A

DL, bronch to remove

steroids if severe obst, mucosal damage, or significant edema

51
Q

How to manage coin ingestion

A

Allow pass if in distal esphagus or if older child if no signs of airway compromise

52
Q

When you need acute intervention for FB

A

acute or potential airway obstruction
esophageal injury
disc/button battery

53
Q

Image findings with button battery, and complications

A

double halo or double ring sign on AP, or step off on lateral
may be mistaken for coin
caustic injury within 1 hr
perf within 6 hr
If >20mm, 12% of young kids swallowing will have major complication (perf, TEF, major vessel injury, stricture, VC paralysis, C-spine injury)

ENT Secrets (79 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions