Stridor

Question 1

Stridor

• sound
• cause
• site
• use

Answer 1

harsh, muscial sound hear when there is partial obstruction of the lower portion of the upper airway

upper trachea and the larynx.

MC
Viral laryngotracheobronchitis (‘croup’)

Rare causes
Epiglottitis
Bacterial tracheitis

Used to dx between causes of Obstructicroup & acute epiglottis

Question 2

Other than stridor what are the clinical signs regarding the cause and severity of upper respiratory airway obstruction

Answer 2

-Relating to cause 
fever+/-
Cough: barking, quiet, absent 
Toxic looking
Onset of stridor 
Duration of stridor : biphasic, when crying at rest 

Severity 
Drooling 
Central cyanosis 
Chest recession: crying, at rest 
O2 saturation
Altered consciousness 
Tachycardia/ tachypnoea

Question 3

Common causes of stridor

Answer 3

MC: croup

A&E:Acute epiglottis

No infection?: Anaphylaxis

structural: larygomalacia

Biphasic: subglottic stenosis

Question 4

Croup
Etio
Clinical features (stridor etc)
Rx

Answer 4

95% viral( parainfluenza)

6 months to 6 years

Harsh, loud stridor & chest recession disappear at rest if mild
Coryza and mild fever
barking cough

Rx:
mild: home manage
Chest resection at rest: oral dexameth
Severe obs: nebulized adrenaline and monitor

Question 5

Epiglottitis

Etio

Clinical features

Dg

Rx

Answer 5

Acute, life-threatening illness
H. influenzae type b, rare since Hib immunization

Mostly aged 1–6 years

High fever toxic-looking
Sat upright w/ open mouth p- struggling to breath 
Painful throat
-drooling from inability  to swallow 
-cough is silent or absent 
-quiet whispering stridor 

Spatula exam of throat shows swollen epiglottis- avoid neighbouring tissues- total obs

Rx

1) Secure airway!
- Urgent intubation w/ general anaesthesia
2) IV antibiotics

Question 6

Bacterial tracheitis ( pseudomembranous croup)

Answer 6

Presents like severe acute epiglottis except

1) loud harsh stridor
2) thick airway secretions
3) staph aureus