Paediatrics: Respiratory Flashcards
What is stertor?
A low-pitched sonorous sound indicating pharyngeal obstruction, e.g: from the tonsils
What is stridor?
A harsh monophonic noise from the trachea or larynx that occurs as a result of narrowing:
• Extrathoracic - usually an inspiratory noise but can be biphasic
• Intrathoracic - biphasic with a loud expiratory noise
Causes of tracheal deviation?
Pushed away by a tension pneumothorax or large effusion
Pulled towards a significant collapse
Differential diagnosis for paediatric stridor?
Viral croup
Epiglottitis
Inhaled foreign body
Acute allergic reaction
Airway burns and scalds, e.g: smoke and steam
Other infections, e.g: retropharyngeal abscess
Mx of acute severe stridor?
Hold the O2 mask near to the child
Call for help (anaesthetist)
May require gaseous induction of anaesthesia and intubation before IV access can be established
Assessment of persistent / recurrent stridor?
Plot on growth chart (consider failure to thrive)
Episodic vs continuous?
Hx of birth trauma / CN anomalies?
Hx of cardiac/thoracic society?
Any cutaneous haemangiomas?
Any swallowing issues? (consider bulbar dysfunction)
Ix for stridor?
Blood tests (rarely, may reveal hypocalcaemia or hypomagnesaemia)
CXR
Flexible laryngobronchoscopy
Causes of persistent inspiratory stridor in infancy?
LARYNGOMALACIA
Vocal cord palsy
Supraglottic OR laryngeal cyst
Laryngeal cleft
Hypocalcaemia or hypomagnesaemia
Lingual thyroid
Causes of persistent biphasic stridor in infancy?
Vocal cord palsy
Subglottic stenosis
Subglottic cyst
Subglottic haemangioma
Branchial cleft cyst
Cystic hygroma
Vascular ring
Causes of persistent stridor in an older child?
If recurrent, consider viral or allergic causes
Vocal cord dysfunction
Rare causes: • Pharyngeal tumour • Neck mass/tumour • Juvenile papillomatosis • Foreign body inhalation • External tracheal compression, e.g: mediastinal lymphoma
Ix for persistent stridor in an older child?
Spirometry
CXR
Flexible laryngoscopy
CT of chest and neck
What is a wheeze?
A whistling, musical noise caused by turbulent airflow passing through narrowed medium-sized airways
Generally this noise is heard on expiration, unless severe
Differential diagnosis of paediatric wheeze?
Asthma
Infection, e.g: bronchiolitis
Chronic lung disease
Cystic fibrosis
Aspiration lung injury / GORD
Moderate allergic reaction
Foreign body inhalation
Vocal cord dysfunction
Heart failure secondary to lymphatic engorgement
Purpose of a cough?
To clear bulk materials from the airway; it can be produced or suppressed through volition
Causes of a dry cough?
Asthma / reactive airway disease
GORD
Post-viral / post-pertussis
Habit cough
Postnasal drip
Tracheobronchomalacia
Drugs causes, e.g: ACEIs
