Lecture 22- Larynx and the airway cases Flashcards
Key features of illness
- Antivaxxer parents
- Harsh respiratory noise- stridor
- Sore throat
- Lethargic
- Sitting in still ‘sniffing’ position
- Dribbling
- Breathing rapidly
- 39.5- pyrexia
- Think infection
What is epiglottitis
- Inflammation of the epiglottitis and supraglottis regions
- Narrowing of laryngeal inlet through inflammation of the epiglottitis
- Usually rare due to Hib vaccination
What would be your differential diagnosis in a patient presenting with similar signs and symptoms (epiglottitis)?
- Croup
- Foreign body in airways
- Laryngeal oedema
- Retropharyngeal abscess
- Common cause of epiglottitis
Haemophilus influenza type B
Pseudomonas aeruginosa related to which H+N infections
Otitis externa
Why do you think the girl sitting with her head held in a sniffing position and what does the hard inspiratory noise suggest?
- Head tilt chin lift
- Holds the airway more patent
- Maintain airway
- Stridor= airway obstruction in the upper respiratory tract
label
A- epiglottis
B- aryepiglottic folds
C- false vocal cords- vestibular fold
D- true vocal cords- vocal folds
where is the supra glottic region found
coloured in yellow
why mus thte doctor not further examine or take bloods from the girl
Distress can decrease the patency of the airway – exacerbate inflammation
- Deterioration causing complete airway obstruction
how would you treat epiglottitis
first: laryngoscopy and endotracheal intubation
then: give IV Abx
order of the structures the endotracheal tube will have to pass to reach the trachea
- oral cavity
- posterior third of the tongue
- epiglottis and aryepiglottic fold
- supraglottis (laryngeal vestibule)
- false vocal cords
- true vocal cords
- infraglottis
- trachea
what is is this
1 Oropharyngeal airway
what is is this
2 Nasopharyngeal airway
what is this
3 Laryngeal mask- supraglottic airway
what is this
Endotracheal tube
key features
-
Key features
- Thyroid operation
- Hoarseness of voice
- Cough
- Gag reflex is weak
- Left vocal fold in a paramedian position (should be more abducted)
why have these symptoms developed
-
Left recurrent laryngeal nerve palsy (branch of vagus nerve)
- Which supplies the left side of the larynx
- Caused by damage in thyroid surgery- local structures (runs in the tracheooesophageal groove)
- Explain why the women’s cough was weak?
- Lack of forcible adduction of the vocal chords (unable to fully raise intrathoracic pressure)
- Due to weakness in left vocal chord (need to adduct together)
- What symptoms might pt develop if the external branch of the superior laryngeal nerve were injured?
- External branch of superior laryngeal nerve innervates the cricothyroid muscle
- When it contracts it tilts the thyroid cartilage forward and downwards, increasing tension in the vocal chords- achieve higher pitch
- Struggle to produce higher pitched sounds
nervous supply to the larynx
Superior laryngeal nerve
- Sensory= supra glottic and true vocal cords (internal laryngeal nerve)
- Motor= cricothyroid (high pitched noises)= external laryngeal
Recurrent laryngeal is motor and sensory to every muscle except the infraglottis
