Stridor and sleep apnoea Flashcards
What is stridor?
This is a predominantly inspiratory wheeze, due to large airway obstruction
What are the 2 types of stridor?
Extra-thoracic (Subglottis)
Supraglottis
What are some causes of supraglottis stridor?
Laryngomalacia
Supraglottic mass
Glottic lesions
Vocal cord paralysis
What are the most common causes of stridor in children?
Infection
Foreign bodies
Anaphylaxis
Angioneurotic oedema
Trauma (e.g. burns)
What are some infections in children that can cause stridor?
Croup
Epiglottitis
Pseudomembranous croup
Retropharyngeal abscess
Diphtheria
Infection mononucleosis (EBV)
What is the most common foreign body that children intake?
Peanuts
What are the most common causes of stridor in adults?
Neoplasm
Anaphylaxis
Goitre
Foreign body
Trauma (e.g. strangulation)
What are some less common causes of stridor in adults?
Bilateral vocal cord palsy
Wegener’s granulomatosis
Cricoarytenoid arthritis
Tracheopathia
Tracheomalacia
What is tracheomalacia?
Degeneration of the tracheal cartilage
What are some investigations in stridor?
Laryngoscopy
Bronchoscopy
Flow volume loop
Chest X-ray
CT scan
Thyroid scan
What is a cricothyroidotomy?
An emergency procedure in which an incision is made between the cricoid and thyroid cartilage and a tube is inserted
What is a tracheostomy?
A procedure in which an incision is made into the trachea, around 2 finger breadths above the sternal notch, and a tube is inserted
What are some symptoms of acute anaphylaxis?
Flushing
Urticaria
Pruritus
Angioneurotic oedema
Abdominal pain
Vomiting
Hypotension - Anaphylactic shock
Stridor, wheeze, respiratory failure
How is acute anaphylaxis usually treated?
IM adrenaline (Epinephrine)
IV antihistamine (Not 1st line)
IV corticosteroids
High flow O2
Nebulised bronchodilators
Endotracheal tube insertion
What are some long term management options in allergies?
Allergen avoidance
Desensitisation (Immunotherapy) - effective in bee venom
What is obstructive sleep apnoea?
This is intermittent upper airway collapse in sleep, causing recurrent arousals and sleep fragmentation
What is the cardinal symptom of obstructive sleep apnoea?
Daytime sleepiness
How is daytime sleepiness measured?
Epworth sleepiness scale
What is the Epworth sleepiness scale?
This requires patients to give a score from 0-3 on how likely they are to sleep during 8 situations
- Sitting and reading
- Watching TV
- Sitting inactive in public
- Car passenger for 1 hour
- Lying down to rest in the afternoon
- Sitting talking
- Sitting after lunch without alcohol
- In car, stopped for a few minutes in traffic
- A total score ≤10 is considered normal
- 0 = Would never doze
- 1 = Slight chance of dozing
- 2 = Moderate change
- 3 = High chance
What causes snoring?
This is a physiological phenomenon caused by relaxation of the pharyngeal dilator muscles during sleep, causing upper airway narrowing, turbulent airflow and vibration of the soft palate and tongue base
What causes obstructive sleep apnoea?
This is caused by relaxation of the pharyngeal dilator muscles during sleep, causing short periods of airway closure, followed by awakening
What is the most common cause of sleep apnoea in children?
Inflamed tonsils
What are some risk factors of obstructive sleep apnoea?
Enlarged tonsils
Obesity
Retrognathia
Acromegaly
Hypothyroidsm
Oropharyngeal deformity
Neurological syndromes
Drugs (e.g. benzodiazepines, opiates, alcohol)
Post-anaesthesia
What is retrognathia?
This is a condition characterised by a set back lower jaw which pushes the tongue back
