STRIDOR Flashcards
treatment of stridor
Administer 5 mg of adrenaline nebulised if stridor is causing moderate or severe respiratory distress.
* Repeat adrenaline as required every ten minutes.
patho that reduces stridor in adults
Below the larynx the adult trachea is well supported by cartilage that prevents airway collapse and reduces expiratory stridor.
when is stridor heard in the breathing cycle
Stridor is predominantly inspiratory, but may have an expiratory component (biphasic stridor).
Children are at higher risk of airway obstruction than adults because they
they have narrower airways with less cartilaginous support.
n the absence of an obvious cause such as trauma or burns, the differential diagnosis of stridor includes:
ū Croup.
ū Epiglottitis.
ū Tracheitis.
ū Foreign body airway obstruction.
ū Pharyngeal abscess.
ū Anaphylaxis.
ū Angioedema.
what is croup
Croup is a viral infection of the upper airway. It is the most common cause of stridor in children, especially children aged six months to two years. The patient usually has an onset of illness over the preceding days, a barking cough that is worse at night and a low grade fever.
what is eppiglottis
Epiglottitis is a bacterial infection of the upper airway. It is now relatively rare as a result of immunisation. Historically it was most common in children aged 2-7 years, but is now more common in adults. The patient usually has an onset of illness over a day or two, a very sore throat, difficulty swallowing (which may cause drooling) and a high grade fever. Epiglottitis is an emergency because the risk of airway occlusion is relatively high.
tracheitis
Tracheitis is a bacterial infection of the trachea. It is relatively uncommon and mainly affects children. It is most commonly due to secondary bacterial infection following a viral infection.
Pharyngeal abscess formation is usually associated with
an onset of illness over the preceding days, a very sore throat, difficulty swallowing and a high grade fever. It is usually a complication of bacterial pharyngitis or tonsillitis.
* Anaphylaxis causing stridor is always associated with signs of systemic involvement, for example hypotension, bronchospasm or rash.
Angioedema is a condition that results in
intermittent, unpredictable and isolated swelling of the mouth, tongue and/or face, in the absence of
systemic signs of anaphylaxis. Angioedema often occurs in patients taking aspirin or angiotensin-converting enzyme (ACE) inhibitors and may occur following administration of fibrinolytic therapy. Angioedema may respond to nebulised adrenaline but do not administer adrenaline IM or IV. This is because angioedema does not improve with parenteral adrenaline and the risks from the adverse effects of adrenaline outweigh any possible benefits.
croup treatment
- Administer 5 mg of adrenaline nebulised if stridor is causing moderate or severe respiratory distress.
- Repeat adrenaline as required every ten minutes.
- Administer prednisolone syrup PO, but this is not a priority if adrenaline is being administered. See the paediatric drug dose tables for dosages.
Children with mild respiratory distress from croup should usually be treated in the community provided:
ū Nebulised adrenaline has not been administered, and
ū Oral prednisolone has been administered, and
ū The patient’s SpO2 is greater than or equal to 94% on air, and
ū The parents or guardians are advised the patient needs to see a doctor
within 24 hours because a further course of oral steroids is required.
