Upper airway compromise Flashcards
What area does Croup affect?
lower laryngeal area
Trachea
Bronchi (occasionally)
Is Croup viral or bacterial?
Viral
What viral infections can lead to Croup?
Parainfluenza, RSV, influenza, adenovirus
how is croup spread?
droplet inhalation or by contact
When is croup most commonly diagnosed?
Late fall and winter
Describe the pathophysiology of croup
initial infection of nasal and pharyngeal mucosa that spreads to respiratory epithelium
infection leads to inflammation of those areas resulting in decreased air flow
What is the narrowest portion of the pediatric airway?
cricoid cartilage
How does Croup present clinically?
- 1-3 day history of cold like symptoms
- Low grade fever
- Hoarse voice
- Barking cough
- Stridor
What might you see on the CXR of a patient with croup?
Steeple sign
How can croup be diagnosed?
Clinical diagnosis based on the presence of
1. Barking cough
2. Stridor
3. Steeple sign
What are options for managing croup?
- Supportive care
- Humidified air/oxygen
- Nebulized racemic epi
- IV steroids
- Heliox
How long does it take for Croup to resolve?
Generally 3-7 days, but as long as 2 weeks
Is epiglottitis the result of a bacterial or a viral infection?
bacterial infection
When is epiglottitis generally seen?
in patients 2-5 years old
Describe the pathophysiology of epiglottitis
result of a bacterial infection that causes acute inflammation of the supraglottic region
What is the bacteria responsible for epiglottitis?
haemophilus influenzae
How does epiglottitis alter breathing?
dysmorphic shape of the epiglottis in the narrowed supraglottic area acts as a ball-valve mechanism producing partial to complete airway obstruction
What does epiglottitis cause?
significant increases in airway resistance and work of breathing
How does epiglottitis present clinically?
- Sore throat
- High grade fever
- Difficulty swallowing
- Drooling
- Tripoding
What are the 4 D’s of epiglottitis?
Drooling, dysphagia, dysphonia, distress
What can you look for on a CXR to confirm the presence of epiglottitis?
Thumb sign
How is epiglottitis managed and treated?
Visualization of the airway to determine level of swelling
Closely monitoring patient
ICU admission
Airway stabilization
What kind of ETT would be inserted in a patient with epiglottitis?
cuffless ETT
What factors lead to foreign body aspiration?
Lack of molar teeth
curiosity and exploration
high distractibility when eating
How might a foreign body aspiration present in the acute stages?
choking
coughing
Severe SOB
Cyanosis
Absent breath sounds
How might a foreign body aspiration present within 24 hours?
Unilateral wheezing
Cough
Stridor
Respiratory distress
Cyanosis
Voice/cry changes
What might a foreign body aspiration look like in the later stages?
Fever
persistent or recurrent cough
wheezing
PNA
atelectasis
lung abscess
hemoptysis
How are foreign body aspirations managed?
Dependent on patients clinical presentation
emergent cricothyrotomy
rigid brochoscopy
specimen sample for proper antibiotic coverage
