SPC- Stridor Flashcards
Know the different causes of stridor and key questions to ask in history taking
What is stridor?
High pitched noise heard due to partially obstructed larynx or large airways
What is stertor?
Inspiratory snoring noise (low pitched), coming from obstruction of the pharynx
Why is any sign of airway obstruction very concerning in children?
Children’s airways are much narrower than adults and so obstruction can occur faster and more dramatically
What are some causes of stridor?
Congenital- Laryngomalacia, web/stenosis, vascular rings
Inflammation- Laryngitis, epiglottitis, croup, anaphylaxis, peritonsilar abscess
Tumours- Haemangiomas, Papillomas
Trauma- Thermal (burns)/chemical, or from intubation
Foreign body
Laryngospasm
What are the different types of stridor?
Inspiratory-(obstruction at or above the glottis)
Expiratory- Obstruction of Bronchi
Biphasic- Obstruction of the trachea
What worrying features should be checked for when a patient presents with stridor?
Stridor is a sign of impending respiratory arrest. Worrying features include: Swallowing difficulty/ Drooling Pallor/ Cyanosis Use of accessory muscles of ventilation Tracheal tug
What is the management of stridor?
This is a medical emergency and should be approached using the ABCDE algorithm. The airway is not patent and this requires urgent action.
- Give Oxygen or Heliox (mixture of oxygen and helium that is less dense and may reduce work of breathing)
- Nebulised Adrenaline (1ml of 1:1000 with 1 ml saline- causes bronchodilatation)
- Monitor O2 saturation, RR, HR,BP
- Escalate and call for ENT/Anaesthetic senior ASAP
- Be brief with history taking from patient or relative
- Secure the airway by the least invasive method possible (intubation, cricothyroidotomy, tracheostomy)
How should the airway be managed if a patient presents with stridor?
- Endotracheal intubation (1st line, move on if not possible)
- Emergency Needle Cricothyroidotomy- If child less than 12 years of age (Very temporary procedure, only sustains life for 30-45 minutes)
- Surgical Cricothyroidotomy
What is croup?
Also called acute laryngotracheobronchitis
Leading cause of stridor (if severe) involving inflammation of the larynx, trachea and bronchioles
What is the main cause of croup?
Viral (95%)- Parainfluenza virus, Respiratory Syncytial virus
What age group is croup commonly seen in?
Children (<6 years of age)
What are the signs of croup?
Stridor
Barking cough
Hoarse voice
Infective signs
What are the worrying signs of croup?
Stridor at rest Cyanosis Low SaO2 Increasing RR Increasing HR Fatigue/Tiredness Altered consciousness level
What is the treatment of croup?
If no stridor and mild can be treated at home
Prednisolone 1-2mg/kg PO or Dexamethasone 0.15mg/kg PO
If severe signs- Nebulised Adrenaline 1:1000
Failure to improve, repeat and refer to ITU
Why is softer stridor more worrying?
Stridor is due to airway obstruction reducing flow. The sound is due to the volume of flow. Reduced volume indicates poor ventilation.
What is acute epiglottitis?
Rapidly progressive inflammation of the epiglottis and adjacent tissues. It is a medical emergency as the inflammation can quickly cause airway obstruction
How may children/adults present with acute epiglottitis?
Difficulty breathing
Swallowing difficulty
Drooling of saliva (as avoid swallowing due to pain)
Sore throat
Fever
Irritability
Muffled voice/crying (as pain created through talking due to inflammatory process)
Cough is absent
(Note- Relatively rare in children due to Hib vaccination, now more commonly presents in adults with severe sore throat and painful swallowing)
What is the management of acute epiglottis?
Keep the patient upright
Do not try to visualise or examine the back of the throat (as this can cause laryngospasm and closure of the airway)
Escalate to an ENT/Anaesthetic Registrar
Diagnosis is made by laryngoscopy and the patient intubated and given dexamethasone and antibiotics
Surgical airway is intubation not possible
What is laryngomalacia?
Main congenital abnormality of the larynx that is often noticeable within hours of birth
Excessive collapse and in-drawing of the supra-glotic airways during inspiration leading to airway obstruction
In 85% no treatment is needed and symptoms usually improve by 2 years old
Problems can occur with concurrent laryngeal infections or with feeding
Surgery can help in severe cases
