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Paediatrics > Upper Respiratory Tract Obstruction > Flashcards

Upper Respiratory Tract Obstruction Flashcards

1
Q

How can we classify upper respiratory tract obstruction?

A
  1. Acute

2. Chronic >14 days

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2
Q

What are the acute causes of upper airway obstruction?

A
  1. Foreign body aspiration
  2. Allergies and GERD
  3. Infections-croup and TB lymphadenopathy, retropharyngeal abcess and acute bacterial epiglottitis
  4. Trauma-intubation injury
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3
Q

What are chronic causes of upper airway obstruction? Usually from birth

A
  1. Laryngomalacia
  2. Trauma- subglottic stenosis
  3. Infections- tonsillitis/ adenoiditis causing sleep apnea and laryngeal papillomatosis
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4
Q

What should we think of if a previously healthy child suddenly has stridor?

A

Foreign body

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5
Q

How do we treat intubation injury?

A

By giving parental steroids

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6
Q

Why does intubation injury occur?

A

Because the cricoid is the narrowest part

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7
Q

What organism causes croup/laryngo-tracheobronchitis?

A

Parainfluenza

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8
Q

How does croup present?

A

With a barking cough, inspiratory stridor and hoarseness

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9
Q

What age is usually affected in croup?

A

6-24 months

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10
Q

What is the grading system for croup?

A

Grade 1- inspiratory stridor treated with observation
Grade 2- inspiratory and expiratory stridor treated with nebulised adrenaline
Grade 3-inspiratory and expiratory stridor with pulsus paradoxus treated with nebulised adrenaline and inbtubation
Grade 4- apnea treated with intubation

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11
Q

Where does the foreign body usually lodge itself in the airway?

A

Between the vocal cords and the cricoid cartilage

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12
Q

What are less common organisms that can cause croup?

A

Measles
Herpes simplex
Candida albicans in hiv positive patients

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13
Q

What is acute bacterial epiglottitis?

A

-it is a rare but extremely dangerous cause of upper airway obstruction

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14
Q

How does acute bacterial epiglottitis present clinically?

A

-inspiratory stridor because of the extremely swollen airway
-difficulty swallowing
-drooling
-sit in a tripod position with their upper body forward and arms supporting them
-when doing an orophanryngeal exam you see the epiglottitis is swollen and cherry red
-

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15
Q

What special investigations can we do in epiglottitis?

A

Usually not done but on X-ray we can see the hitchhikers thumb

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16
Q

What is the management of epiglottitis?

A
  • INTUBATION!! Then

- ampicillin or ceftriaxone or corticosteroids is given

17
Q

How can we dislodge a foreign body that is aspirated in a life threatening region?

A

Heimleich maneuvere

18
Q

Where is the retropharynx?

A

The area anterior to the cervical spine

19
Q

How do patients with retropharyngeal abscesses present?

A
  • fever and very ill
  • enlarged cervical lymph nodes
  • stridor
20
Q

What would you see on lateral X-ray in retropharyngeal abscess?

A

A bulging mass

21
Q

How do we treat a retropharyngeal abscess?

A
  1. Use a broad spectrum AB but can use ampicillin and the go home with amoxicillin
  2. Clindamycin is a broad spectrum antibiotic
  3. Drain the abscess
22
Q

What is bacterial trancheitis

A

Bacterial infection of the trachea presenting with stridor and fever
We treat with broad spectrum AB like amoxicillin/clavulanic acid

23
Q

In regards to intubation injury what usually causes the injury and subsequent oedema?

A

Usually caused by the wrong endotracheal tube

24
Q

What is laryngomalacia?

A

It is softening of the larynx causing collapse during inspiration leading to stridor

25
Q

When does laryngomalacia present?

A

It usually presents around 14 days after birth

26
Q

What should we always look for in laryngomalacia?

A

Gastric-oesophageal reflux

27
Q

What are the anatomical abnormalities that can occur in the upper airway?

A
  1. Subglottic stenosis

2. Cysts and webs

28
Q

What is laryngeal paillomatosis?

A
  • viral infection caused by HPV leading to outgrowths from any part of the larynx leading to stridor usually accompanied by hoarseness and aphonia
29
Q

How do we treat laryngeal papillomatosis?

A

Laser therapy

30
Q

What are the complications of obstructive sleep apnea if not sorted out early enough?

A
  1. It can lead to snoring and episodes of apnea which causes waking up of the child
    This can lead to poor concentration during the day, failure to thrive, enuresis, poor school performance and in extreme cases pulmonary hypertension and cor pulmonale
31
Q

What do children with obstructive sleep apnea usually present with?

A
  1. Usually have enlarged adenoids and tonsils

2. Or anatomical abnormalities or Down’s Syndrome or obesity

Paediatrics (40 decks)

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