Upper Respiratory Tract Obstruction Flashcards
How can we classify upper respiratory tract obstruction?
- Acute
2. Chronic >14 days
What are the acute causes of upper airway obstruction?
- Foreign body aspiration
- Allergies and GERD
- Infections-croup and TB lymphadenopathy, retropharyngeal abcess and acute bacterial epiglottitis
- Trauma-intubation injury
What are chronic causes of upper airway obstruction? Usually from birth
- Laryngomalacia
- Trauma- subglottic stenosis
- Infections- tonsillitis/ adenoiditis causing sleep apnea and laryngeal papillomatosis
What should we think of if a previously healthy child suddenly has stridor?
Foreign body
How do we treat intubation injury?
By giving parental steroids
Why does intubation injury occur?
Because the cricoid is the narrowest part
What organism causes croup/laryngo-tracheobronchitis?
Parainfluenza
How does croup present?
With a barking cough, inspiratory stridor and hoarseness
What age is usually affected in croup?
6-24 months
What is the grading system for croup?
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
Where does the foreign body usually lodge itself in the airway?
Between the vocal cords and the cricoid cartilage
What are less common organisms that can cause croup?
Measles
Herpes simplex
Candida albicans in hiv positive patients
What is acute bacterial epiglottitis?
-it is a rare but extremely dangerous cause of upper airway obstruction
How does acute bacterial epiglottitis present clinically?
-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
-
What special investigations can we do in epiglottitis?
Usually not done but on X-ray we can see the hitchhikers thumb
What is the management of epiglottitis?
- INTUBATION!! Then
- ampicillin or ceftriaxone or corticosteroids is given
How can we dislodge a foreign body that is aspirated in a life threatening region?
Heimleich maneuvere
Where is the retropharynx?
The area anterior to the cervical spine
How do patients with retropharyngeal abscesses present?
- fever and very ill
- enlarged cervical lymph nodes
- stridor
What would you see on lateral X-ray in retropharyngeal abscess?
A bulging mass
How do we treat a retropharyngeal abscess?
- Use a broad spectrum AB but can use ampicillin and the go home with amoxicillin
- Clindamycin is a broad spectrum antibiotic
- Drain the abscess
What is bacterial trancheitis
Bacterial infection of the trachea presenting with stridor and fever
We treat with broad spectrum AB like amoxicillin/clavulanic acid
In regards to intubation injury what usually causes the injury and subsequent oedema?
Usually caused by the wrong endotracheal tube
What is laryngomalacia?
It is softening of the larynx causing collapse during inspiration leading to stridor
When does laryngomalacia present?
It usually presents around 14 days after birth
What should we always look for in laryngomalacia?
Gastric-oesophageal reflux
What are the anatomical abnormalities that can occur in the upper airway?
- Subglottic stenosis
2. Cysts and webs
What is laryngeal paillomatosis?
- viral infection caused by HPV leading to outgrowths from any part of the larynx leading to stridor usually accompanied by hoarseness and aphonia
How do we treat laryngeal papillomatosis?
Laser therapy
What are the complications of obstructive sleep apnea if not sorted out early enough?
- 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
What do children with obstructive sleep apnea usually present with?
- Usually have enlarged adenoids and tonsils
2. Or anatomical abnormalities or Down’s Syndrome or obesity
