Stridor and sleep apnoea Flashcards
What is stridor?
A predominantly inspiratory wheeze due to large airways (larynx/trachea/major bronchi) obstruction
What structures can cause stridor when they become smaller?
Extrathoracic
Supraglottis/larynx: laryngomalacia, supraglottic mass, glottic lesions, vocal chord paralysis
What can infections can cause stridor in children?
Croup - RSV Epiglottitis Pseudomembranous croup Retropharyngeal abscess Diptheria Infections mononucleosis (glandular fever)
What things other than infection can cause stridor in children?
Foreign body
Anaphylaxis
Other (burns)
What can cause stridor in adults?
Neoplasms - larynx, trachea, major bronchi
Anaphylaxis
Goitre (retrosternal)
Trauma (strangulation, burns, irritant gases)
Other (bilateral vocal chord collapse, wegener’s granulomatosis, cricoarytenoid arthritis (RA)
Most common cause of stridor in adults is a tumour around the carina
What is trachemalacia?
Any inflammatory condition that affects the cartilage rings in the trachea
What can cause changes to the voice?
Benign upper airway inflammatory polyp’s
How is stridor investigated?
Laryngoscopy Bronchoscopy Flow volume loop CXR CT, thyroid scan
How is laryngeal obstruction treated?
Underlying cause e.g. foreign body removal, anaphylaxis
Mask bag ventilation with high flow ocygen
Cricothyoidotomy
Tracheostomy - needs surgeon
When is the heimlich manoeuvre used and what is the mechanism?
Foreign body inhalation
Rapid upward thrust in epigastrium forces upward movement of diaphragm and forced expiration
How is a malignant airway obstruction treated?
Tumour removal: laser, photodynamic therpy, cryotherapy, diathermy, surgical resection
Tumour compression: intraluminal stent
Radiotherapy: external beam, brachytherapy
Chemotherapy
Corticosteroids
What type of reaction is acute anaphylaxis?
Type 1 (intermediate) hypersensitivity (IgE)
What are the symptoms of acute anaphylaxis?
Flushing, pruritus, uticaria, angioneurotic oedema (lips, tongue, face, larynx, bronchi)
Abdominal pain, vomiting
Hypotension (vasodilation and plasma exudation), circulation collapse (shock)
Stridor, wheeze and resp failure
What can cause anaphylaxis?
Foods - nuts, shellfish
Insect venom (bee, wasp)
Drugs (penicillin, asprin, anaesthetics)
Latex
How can anaphylaxis be treated?
IM adrenaline - NEVER IV IV antihistamine IV corticosteroid - immunosuppresion High flow O2 Nebulised bronchodilator Endotracheal intubation Allergen avoidance Densisitation (immunotherapy) Self-administered epi
What can happen if adrenaline is given IV not IM?
Induce ventricular tachycardia
What is the epworth sleepiness scale?
The changes of dozing in certain situations
What are some situations measured in the epworth sleepiness scale?
Sitting and reading Watching TV Sitting inactive in pubilc Car passenger for 1hr Lying down to rest in the afternoon Sitting talking Sitting after lunch without alcohol In car, stopped for few minutes in traffic
What are the different scales on the epworth sleepiness scale?
0 = would never dose 1 = slight change of dozing 2 = moderate chance 3 = high change
What is the normal number on the epworth sleepiness scale?
10-24
What is snoring?
Relaxation of pharyngeal dilator muscles during sleep (esp. REM)
This causes airway narrowing, turbulent airflow and vibration of soft palate and tongue base
What happens during the hypotonic state in sleep?
All the muscles relax. The throat can flop in the way which is fine for most people but in some people it will cause snoring
What is obstructive sleep apnoea?
Intermittent upper airway collapse in sleep
Apnoeas or hypopnoeas cause hypoxaemia
This causes recurrent arousals/ sleep fragmentation
What are the risk factors for sleep apnoea?
Enlarged tonsils, adenoids Obesity Retrognathia Acromegaly, hypothyroidism Oropharyngeal deformity Neurological: stroke, MC, myesthenia gravis, myotonic dystrophy Drugs: benzodiazepines, opiates, alcohol Post-operative period after anaesthesia
What are the cosequences of sleep apnoea?
Excessive daytime sleepiness Personality change Cognitive /functional impairment Major impact on daytime function Independent risk factor for hypertension Activated sympathetic system Raised CRP Impaired endothelial function Impaired glucose tolerance
What can improve sleep apnoea?
CPAP
How is sleep apnoea diagnosed?
Snoring and EDS (raised Epworth score)
Overnight sleep study: Oximetry, domicillary recording (airflow, oximetry, thoracic/abdominal movement)
Full polysomnography
How is obstructive sleep apnoea treated?
Remove underlying cause
CPAP (continous positive airway pressure) - this is the most effective therapy
