Stridor Flashcards
What is stridor?
Common causes?
Harsh, musical sound due to partial obstruction of the lower portion of the upper airway (trachea and larynx)
Usually inspiratory
Croup - viral laryngealtracheobronchitis, where mucosal inflammation and swelling can cause obstruction
Rare: epiglotitis, bacteria tracheaitis (pseudomembranous group), foreign body, allergic laryngeal angioedema (anaphylaxis), smoke, trauma, lymph node swelling (infection mononucleosis, malignancy, TB), retropharyngeal abscess
How can upper airway obstruction severest be assessed?
Characteristics of striker: none, only when crying, at rest inspiratory, biphasic
Degree of chest retraction: none, crying, at rest
Subcostal, intercostal sternal recession
RR
HR
Agitation
What may be seen in severe obstruction of upper airway?
Increased RR, HR Agitaiton Central cyanosis Drooling Reduced consciousness SaO2 - hyperaemia (late feature)
What is croup? Common cause? age?
Viral laryngotracheal infection Parainfluenza viruses Rhinovirus RSV Influenza
6m to 6y peak at 2yo
common in autumn?
Features of croup?
Coryza and fever followed by:
Hoarseness due to inflammation of vocal cords
Barking cough due to tracheal oedema and collapse
Harsh stridor
Variable degree of difficulty breathing with chest retraction
Symptoms often start and are worse at night
Management of croup?
When upper airway obstruction is mild, stridor and recession disappear at rest and child can be managed at home and monitored for signs of increasing severity
Oral dexamethasone, prednisone or nebuliser steroids (budesonide) reduce severity and duration of croup - first line for croup causing chest recession.
In severe upper airway obstruction - nebuliser adrenaline with oxygen by face mask gives rapid but transient improvement.
Observe child as effect wear off.
What is acute epiglottitis?
Cause? Age?
Intense swelling of epiglottis and surrounding tissues associated with sepsis.
Life- threatening emergency due to risk fo obstruction
Haemophilus influente type b (Hib)
Universal His immunisation in infancy has led reduced incidence
Common in 1-6 yo
Describe clinical features of epiglottitis
High fever in a very ill, toxic looking child
Intensely painful throat, prevents child from speaking or swallowing - drooling saliva
Soft inspiratory stridor and rapidly increased respiratory difficulty over hours
Child sitting immobile, upright with open mouth to optimise airway.
How to differentiate between epiglottitis and viral croup?
Cough is minimal or absent in epiglottitis.
Attempts to lie child down and examine throat in epiglottitis must not be undertaken as they can precipitate total airway obstruction.
Management of acute epiglottitis?
Urgent hospitalisation
Senior anaesthetist, paediatrician, ENT surgeon.
ITU
Intubated with nasotracheal/NG tubes
Urgent tracheostomy if required
Blood culture and IV abx such as cefuroxxime.
Tracheal tube removed after 24h and abx for 3-5 days
Rifampicin prophylaxis offered to household contacts for H-influenzae
What is bacterial tracheitis?
Pseudomembranous croup
High fever, rapidly progressive airway obstruction with copious thick airway secretions caused by Staph aureus infection.
IV abx, intubation and ventilation if required.
What should you consider in abrupt onset of stridor?
Anaphylaxis, inhaled foreign body
What should you consider in chronic stridor?
Structural problem from intrinsic narrowing or collapse of laryngotracheal airway:
Stenosis,
External compression, nodes, tumours
