Extra-Thoracic Airway Disorders

Question 1

Croup (Laryngotracheitis)

Answer 1

Acute Spasmodic:

• obstructive narrowing of the larynx caused by mucosal edema in the subglottic area
• usually affects children 6 months - 6 years w/ peak age 9-18 months
• mostly viral
• most frequently at night
• occurs most often in the fall/winter
• sudden onset

Question 2

Croup: Sx

Answer 2

• URI
• croupy cough
• stridor
• retractions
• increased RR
• increased WOB
• hoarseness
• dyspnea
• restlessness
• anxiety
• sx awaken child, but go away during the day

Question 3

Croup: Dx

Answer 3

• clinical diagnosis

- subglottic narrowing on radiograph

Question 4

Croup: Management

Answer 4

• humidified air
• nebulized epinephrine
• corticosteroids
• cough/cold medications not recommended
• bronchodilators if bronchospasm occurs
• oxygen if <92%
• heliox for severe croup (mixture of helium and oxygen)
• expose to cold air

Question 5

Croup: Indications for Hospitalization and what treatments given

Answer 5

• RR of 70-90
• temp >102.2

Tx:

• racemic epinephrine in conjunction w/ corticosteroids
• hydration/IV fluids

Question 6

Croup: Complications

Answer 6

continuous stridor
hypoxia
weakness
death

Question 7

Croup: Goals

Answer 7

• close observation for respiratory distress caused by obstruction
• relieve anxiety
• decrease edema
• ease respiratory effort

Question 8

Epiglottitis

Answer 8

• inflammation of the epiglottis caused by H. influenzae type B
• usually from 1-5YO

Question 9

Epiglottitis: S/Sx

Answer 9

abrupt onset of:

• fever
• severe sore throat
• dyspnea
• inspiratory distress w/o stridor
• drooling

Physical exam findings:

• drooling (can’t swallow b/c throat hursts too much)
• aphonia
• high fever
• rapidly progressive respiratory obstruction (usually worsen over 2-4hrs)
• severe retractions
• hyperextension of neck
• dysphagia
• stridor aggravated when supine
• toxic looking
• rapid pulse and RR
• mouth breathing w/ hyperextended neck (tripod poistion)
• muffled voice

Question 10

Epiglottitis: Dx

Answer 10

• blood culture

- lateral neck radiograph before physical exam w/ provider capable of intubation present

Question 11

Epiglottitis: Management

Answer 11

• decrease anxiety
• DO NOT EXAMINE THROAT
• position for comfort
• trach tray available
• establish airway
• start antimicrobials IV
• administer O2/respiratory support

Question 12

Epiglottitis: Complications

Answer 12

systemic spread of organism

Question 13

Epiglottitis: Prevention

Answer 13

HIB Immunization