Stridor and Sleep Apnoea Flashcards
What is stridor
Inspiratory wheeze due to large airways (larynx/trachea/major bronchi) obstruction
What is croup
Laryngotracheobronchitis caused by a viral infection that leads to swelling inside the trachea causing a barking cough
What is tracheomalacia
Tracheal cartilage becomes flaccid causing widening of posterior membranous wall and reducing airway calibre. This can cause tracheal collapse
How can stridor be investigated
Laryngoscopy, bronchoscopy, spirometry, chest x-ray and other imaging (CT scan, thyroid scan)
Treatment of laryngeal obstruction
Treat underlying cause such as foreign body removal, mask bag ventilation with high flow O2, cricothyroidotomy, tracheostomy
Cricothyroidotomy vs tracheostomy
Cricothyroidotomy - Incision made through skin and cricoid membrane to establish a patent airway
Tracheostomy - Opening in front of neck so tube can be inserted
What type of hypersensitivty is anaphylaxis
Type 1 (immediate) hypersensitivity - IgE
Symptoms of acute anaphylaxis
Flushing, urticaria, pruritus, angioneurotic oedema, abdominal pain, vomiting, hypotension, stridor, wheeze and respiratory failure
Why hypotension in acute anaphylaxis
Vasodilation and plasma exudation leading to circulatory collapse and shock
Why wheeze and stridor in acute anaphylaxis
Due to inflammation of larynx and bronchi
Treatment of anaphylaxis
BOCAE - Bronchodilators nebulized Oxygen, high flow Corticosteroids IV Antihistamine IV Epinephrine IM
What causes snoring
Relaxation of pharyngeal dilator muscles during sleep. Upper airway narrows causing turbulent airflow and vibration of soft palate and tongue base
What is sleep apnoea
Repeat starting and stopping of breathing during sleep
Comon sign of obstructive sleep apneo
Snoring
What drugs can cause sleep apnoea
Benzodiazepine, opiates, alcohol, post operative after anaesthesia
Consequences of sleep apnoea
Excessive daytime sleepiness, personality change, cognitive/functional impairment, major impact on daytime function
Adverse health effects of sleep apnoea
Independent risk factor for hypertension, activated sympathetic system, raised CRP, impaired endothelial function, impaired glucose tolerance, increase risk of CV events and stroke
How can obstructive sleep apnoea be diagnosed
Overnight sleep study -
Oximetry, domiciliary recording of oximetry/airflow/thoracic/abdominal movement, full polysomnography
Treatment of obstructive sleep apnoea
Remove underlying cause
CPAP - Continuous positive airway pressure
Other treatment for sleep apnoea
Mandibular advancement device -
Improves snoring
Moderate reduction in number of apnoeas recorded during study per hour of sleep
Used in mild obstructive sleep apnoea
Surgery -
Avoid if sleep apnoea as CPAP in future becomes less effective
Used in simple snoring
Surgery option for sleep apnoe
Uvulopalatopharyngoplasty - Remodel/remove tissue in throat
