Stridor Flashcards
What is stridor? What is stertor?
High pitched inspiratory noise due to partial obstruction at the larynx or large airways
Stertor - inspiratory snoring noise from obstruction of the pharynx
What should you look for in a patient with stridor?
Swallowing difficulty/drooling
Pallor/cyanosis
Use of accessory muscles in breathing
Downward plunging of trachea with respiration (tracheal tug)
–> Impending obstruction
What are causes of stridor?
Congenital:
Laryngomalacia, web/stenosis, vascular rings
Inflammation:
Laryngitis, epiglottitis, croup, anaphylaxis
Tumours:
Haemangiomas or papillomas
Trauma:
Therma/chemical or from intubation
What are features of croup? Cause? Management?
Laryngotracheobronchitis
Barking cough ± respiratory distress due to upper airway obstruction
Worse at night
Parainfluenza virus
Single dose of dexamethasone or prednisolone
Usually self-limiting and resolves within 48 hrs
Admit if not settling or severe for supportive management
What is mild/moderate/severe croup?
Mild: occasional cough, no stridor at rest
Moderate: frequent cough, stridor at rest
Severe: frequent cough, stridor at rest, respiratory distress
What is acute epiglottitis? How does it present?
Rapidly progressive inflammation of the epiglottis and adjacent tissues.
Children 2-4 years present with short hx of fever, irritability, sore throat, pooling and drooling of saliva, muffled voice or cry.
They prefer to lean forward and breath tentatively
No cough
Stridor
Adult with severe sore throat and painful swallowing
What causes acute epiglottitis?
Haemophilus influenza b (vaccine has reduced prevalence)
How is acute epiglottitis managed?
Keep patient upright Do not examine throat or cause distress Anaesthetist and ENT Intubation Dexamethasone Abx
What is laryngomalacia?
Management?
Congenital anomaly of larynx
Excessive collapse and undraping of the supraglottic airways during inspiration leading to stridor, and breathing and feeding difficulties
Stridor may be most noticeable during sleep or if excited
Improves by 2 years old
Recurrent laryngeal infection of feeding problems can indicate surgery
What causes vocal cord palsy?
How does it manifest? What is management?
Laryngeal paralysis
Might be due to vagal nerve stretching at birth
Unilateral - hoarse breathy cry in first few weeks aggravated by agitation, feeding difficulty and aspiration
Supportive management 2-3 years to recover
Bilateral - inspiratory stridor at rest that worsens on agitation ± respiratory distress
Mx: Urgent airway intervention - intubation, tracheotomy
Describe management for acute airway obstruction.
Oxygen or Heliox
Nebulised adrenaline 1:1000 1ml
Note SaO2, RR, pule, BP
Anaesthetist, ENT
Endotracheal intubation
Emergency needly cricothyroidotomy - temporary measures pending formal tracheostomy
Wide bore canal through the cricothyroid membrane
Surgical cricothyroidotomy - quicker and easier to perform than emergency tracheostomy but not usually performed in children <12 years
What can drooling be due to in children?
Angioedema Epiglottitis Rabies Neurodisabiltiy - Cerebral palsy Msucle problems Ingestion of foreign body Head and neck trauma Enlarged tonsils or adenoids
