Stridor and Sleep Apnoea Flashcards
What are the two locations for inspiratory stridor?
Extrathoracic
Supraglottis/larynx
What 4 factors can affect the supraglottis/larynx and cause inspiratory stridor?
Laryngomalacia
Supraglottic mass
Glottic lesions
Vocal cord paralysis
What are the 4 main causes of stridor in children?
Infections
Foreign body
Anaphylaxis/angioneurotic oedema
Other (burns)
What do these infections all cause in children - croup, epiglottistis, pseudomembranous croup, retropharyngeal abscess, diphtheria and infectious mononucleosis?
Stridor
What are 4 causes of stridor in adults?
Neoplasms
Anaphylaxis
Goitre (retrosternal)
Trauma (e.g. strangulation, burns and irritant gases)
What are the three main neoplasms that cause stridor in adults?
Larynx
Trachea
Major bronchi
What do these conditions cause - bilateral vocal cord palsy, Wegener’s granulomatosis, cricoarytenoid arthritis, RA and tracheopathia?
Stridor in adults
What are the 4 main investigations for stridor?
Laryngoscopy (beware of acute epiglottitis)
Bronchoscopy
Flow volume loop
CXR
What are the 4 methods of treatment for laryngeal obstruction?
- Treat underlying cause - foreign body removal/anaphylaxis
- Mask bag ventilation with high flow oxygen
- Cricothyroidotomy
- Tracheostomy
What is the name for a rapid upward thrust in epigastrium to force upward movement of diaphragm and force expiration?
Heimlich manoeuvre
What are 4 treatment methods for a malignant airway obstruction?
- Tumour removal - laser, photodynamci therapy, cryotherapy
- Tumour compression - intraluminal stent
- Radiotherapy
- Chemotherapy; corticosteroids
What type of reaction is acute anaphylaxis?
Type I (immediate) hypersensitivity (IgE)
What are these all a sign of - flushing, pruritus, urticaria, angioneurotic oedema, abdominal pain/vomiting, hypotension (vasodilatation and plasma exudation) - circulatory collapse (shock), stridor, wheeze and respiratory failure?
Acute anaphylaxis
Give the 6 treatment steps for anaphylaxis
- IM epinephrine (adrenaline)
- IV anti-histamine
- IV corticosteroid
- High flow oxygen
- Nebulised bronchodilators
- Endotracheal intubation if necessary
What causes snoring?
Relaxatopm of pharyngeal dilator mjuscles during sleep
What is the term for a predominantly inspiratory wheeze due to large airways (larynx/trachea/major bronchi) obstruction?
Stridor
What causes obstructive sleep apnoea?
Intermittent upper airway collapse in sleep
What are enlarged tonsils and adenoids, obesity, retrognathia, acromegaly, hypothyroidism, oropharyngeal deformities, stroke, MS, myesthenia gravis, myotonic dystrophy, benzodiazepines, opiates, alcohol?
Risk factors for sleep apnoea
What is sleep apnoea an indeopendent risk factor for?
Hypertension
What causes raised CRP?
Sleep apnoea
What two things does sleep apnoea impair?
Endothelial function and glucose tolerance
What could be suspected if a patient has snoring and EDS (raised Epworth score)?
Obstructiev sleep apnoea
What three investigations in an overnight sleep study could be used to diagnose obstructive sleep apnoea?
Oximetry Domicillary recording (airflow, oximetry, thoracic/abdominal movement) Full polysomnography
What does CPAP stand for?
Continuous positive airway pressure
What is the most effective therapy for sleep apnoea?
CPAP
What device is used in mild obstructive sleep apnoa, improves snoring and has a moderate reduction in AHI?
Mandibular advancement device
