Stridor Flashcards
What is stridor?
A high pitched noise heard on inspiration from partial obstruction at the larynx or laryngeal airways
What is stertor?
An inspiratory snoring noise, coming from obstruction of the pharynx
Children’s airways are narrower than adults, so obstruction occurs…
Faster and more dramatically
What should you look for?
Swallowing difficulty/ drooling
Pallor/ cyanosis
Use of accessory muscles of respiration
Downward plunging of trachea with respiration (tracheal tug)
All mean impending obstruction
What congenital causes are there?
Laryngomalacia
Web/stenosis
Vascular rings
What inflammatory causes are there?
Laryngitis
Epiglottitis
Croup
Anaphylaxis
What tumours can cause stridor?
Haemangiomas
Papillomas
Hay kind of trauma can cause stridor?
Thermal or chemical, or from intubation
What is the most common cause of stridor?
Laryngotracheobronchitis/ croup
Other than stridor, what other symptoms/signs are associated with croup?
Barking cough
Hoarse voice
Respiratory distress
When is croup often worse?
At night
What usually causes croup?
Usually viral - parainfluenza, influenza
How is croup treated?
Give all children with mild, moderate or severe croup a single dose of dexamethasone 0.15mg/kg
Advise parents that it is usually self limiting and resolves within 48 hours
Admit is moderate or severe croup
Describe the severity grading of croup
Mild - occasional cough, no stridor at rest
Moderate - frequent cough, stridor at rest
Severe - as moderate and respiratory distress
Is croup common?
Yes relatively common - affects 15% of children at some point
What is Hoover’s sign?
Indrawing of the chest wall
Describe the pathophysiology of croup
The viral infection leads to swelling of larynx, trachea and large bronchi due to infiltration of white blood cells. Swelling produces airway obstruction- increased work of breathing and the characteristic noisy airflow (stridor)
What can be seen on AP CXR?
Steeple sign - narrowing of trachea
Is suggestive of croup but is absent in half of cases
What is laryngomalacia?
The main congenital anomaly of the larynx
There is excessive collapse and indrawing of the supraglottic airways during inspiration leading to stridor, breathing and feeding difficulties.
Is treatment usually needed for laryngomalacia?
85% no treatment needed at symptoms improve by 2 years old
Surgery can help in severe cases
What does laryngomalacia literally mean?
Soft larynx
