Stridor and Sleep apnoea Flashcards
what is stridor
predominantly inspiratory wheeze due to large airways obstruction
what are the large airways
larynx, trachea, major bronchi
what type of wheeze is associated with asthma
expiratory wheeze as asthma is obstruction of small airways
narrowing where in the airways will give you inspiratory stridor
extrathoracic, supraglottis/larynx
what can cause narrowing of the supraglottis/larynx
tumour (supraglottic mass), laryngomalacia (softening of the larynx tissue), glottic regions, foreign body, vocal chord paralysis, collapse of bone/cartilage
what stridor occurs when there is unilateral vocal chord paralysis
none
what are causes of stridor in children
infections, forgein body, anaphylaxis/angioneurotic oedema (swelling), others e.g burns
what infections cause stridor in children
group (RSV), epiglottis, diphtheria
what pathogen causes epiglottis in children
haemophilus influenzae
where are sites of tumours in adults that cause stridor
larynx, trachea, major bronchi,
what causes stridor in adults
NEOPLASMS, anaphylaxis, goitre, trauma, other
what side of the airway does inhaled food tend to go down
right as more vertical
what is tacheomalacia
when the airway collapses
how is stridor investigated
laryngosccopy, bronchoscopy, flow volume loop, CXR, other imaging- CT, thyroid scan
when should you be cautious of doing a laryngoscopy
in acute epiglottitis as can make swelling worse and cause respiratory arrest
how is laryngeal obstruction treated
treat underlying cause (removal of foreign body/anaphylaxis), mask bag ventilation with high flow O2, cricothyroidotomy, tracheostomy
how is malignant airway obstruction treated
tumour removal, tumour compression (stent), radiotherapy, chemotherapy
what is acute anaphylaxis
type 1 (immediate) hypersensitivity (IgE)
what are the symptoms of acute anaphylaxis
flushing, pruritus (itch), urticaria (hives), angioneurotic oedema (swelling), abdominal pain, vomiting, hypotension (vasodilatation and plasma exudation), circulatory collapse (shock), stridor, wheeze and resp failure
how is anaphylaxis treated
IM (NOT IV) epinephrine, IV antihistamine, IV corticosteroid, high flow O2, nebulised bronchodilators, endotracheal intubation if necessary
what cells release histamines
mast cells
what effect do steroids have when treating anaphylaxis
immunosuppressants
what causes a rash in anaphylaxis
swings in intrapleural pressures
what is the later treatment for anaphylaxis
allergen avoidance, desensitisation, self administered epinephrine
what is snoring
relaxation of the pharyngeal dilator muscles during sleep causing airway narrowing, turbulent airflow and vibration of soft palate and tongue base
what is obstructive sleep apnoea
intermittent upper airway collapse in sleep
what effect does obstructive sleep apnoea have on patients
recurrent arousals/ sleep fragmentation
what are the risk factors for sleep apnoea
enlarged tonsils, obesity, neurological, drugs, post-op, deformity
what are the resulting social consequences of sleep apnoea
excessive daytime sleepiness, personality change, cognitive/ functional impairment
what are the physiological consequences of sleep apnoea
independent risk factor for hypertension, activated sympathetic system, raised CRP, impaired endothelial function and glucose tolerance
how are all the physiological consequences of sleep apnoea improved
CPAP machine- continuous positive airway pressure
how is sleep apnoea diagnosed
snoring and raised epworth score, overnight sleep study
how is sleep apnoea treated
remove underlying cause, CPAP
what are other treatments for sleep apnoea
mandibular advancement device, surgery
