Stridor Flashcards
what is stridor ?
predominantly inspiratory wheeze due to large airways (larynx/trachea/major bronchi) obstruction
what are some causes of inspiratory stridor?
laryngomalacia
supraglottic mass
glottic lesions
vocal cord paralysis
what are the causes of stridor in children?
infections
foreign body
anaphylaxis/ angioneurotic oedema
other: toxic damage to membranes - from burns or chemical inhalations
what is laryngomalacia?
is the most common cause of stridor in infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction.
what infections cause stridor?
croup
epiglottitis
pseudomembranous croup - rare
retropharyngeal abscess
diptheria
infectious mononucleosis
what virus causes croup?
RSV
what is croup?
inflammation of the larynx and trachea in children, associated with infection and causing breathing difficulties.
which organisms cause epiglottitis ?
almost always croup
where is the retropharyngeal abscess?
behind the soft tissues of neck
what organisms cause infectious mononucleisis ?
virus - can cause upper airway narrowing
what is the main difference between adult and child infections ?
children are more likely to get viral infections
what history would lead you to think of aspirated foreign body causing stridor?
acute onset stridor accompanied by a choking spell but need to do a CXR to exclude other things
what are the main causes of stridor in adults?
neoplasms
anaphylaxis
goitre
trauma
other
what are the less common causes of stridor in adults?
bilateral cord palsy - cant open larynx properly
wegener’s granulomatosis
cricoarytenoid arthritis ( RA
tracheopathia
what is the most common place for neoplasm in smokers?
larynx
what are the other places for neoplasm?
trachea
major bronchi - lung cancers
what investigations should be done for stridor?
laryngoscopy (beware in acute epiglottitis)
bronchoscopy
flow volume loop
CXR
CT and thyroid scan
what is the X ray good for?
good for excluding things
how is laryngeal obstruction treated?
treat underlying cause e.g. foreign body removal anaphylaxis
mask bag ventilation with high flow O2
cricothyroidotomy
tracheostomy - bypassing the obstruction
who may have a
cricothyroidotomy?
someone who has maybe had a chemical burn
how is malignant airway obstruction treated?
tumour removal
tumour compression
radiotherapy
chemotherapy
how is tumour compression done?
intraluminal stent
how is tumour removal done?
laser; photodynamic therapy - inject a drug which is inactive but rapidly taken up by fast metabolising cells - shine light and cause cells to die which have the drug in them;
cryotherapy - freeze the tumour with local freezing ;
diathermy - electrical current burns it away ;
surgical resection
what are the signs of acute anaphylaxis?
Type 1 (immediate) hypersensitivity (IgE)
Flushing, pruritus, urticaria,
Angioneurotic oedema (lips, tongue→ face, larynx, bronchi)
(abdominal pain, vomiting)
Hypotension (vasodilatation and plasma exudation)→ circulatory collapse (shock)
Stridor, wheeze and respiratory failure
what are the causes of anaphylaxis?
Foods eg nuts; shellfish
Insect venom (bee, wasp)
Drugs (eg penicillin is most common and it is usually just a rash, aspirin, anaesthetics)
Other eg latex
what is the treatment for anaphylaxis ?
IM Epinephrine (adrenaline) IV antihistamine IV corticosteroid High flow O2 Nebulised bronchodilators Endotracheal intubation if necessary
