SPC- Stridor Flashcards

Know the different causes of stridor and key questions to ask in history taking

1
Q

What is stridor?

A

High pitched noise heard due to partially obstructed larynx or large airways

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2
Q

What is stertor?

A

Inspiratory snoring noise (low pitched), coming from obstruction of the pharynx

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3
Q

Why is any sign of airway obstruction very concerning in children?

A

Children’s airways are much narrower than adults and so obstruction can occur faster and more dramatically

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4
Q

What are some causes of stridor?

A

Congenital- Laryngomalacia, web/stenosis, vascular rings
Inflammation- Laryngitis, epiglottitis, croup, anaphylaxis, peritonsilar abscess
Tumours- Haemangiomas, Papillomas
Trauma- Thermal (burns)/chemical, or from intubation
Foreign body
Laryngospasm

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5
Q

What are the different types of stridor?

A

Inspiratory-(obstruction at or above the glottis)
Expiratory- Obstruction of Bronchi
Biphasic- Obstruction of the trachea

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6
Q

What worrying features should be checked for when a patient presents with stridor?

A
Stridor is a sign of impending respiratory arrest. Worrying features include:
Swallowing difficulty/ Drooling
Pallor/ Cyanosis
Use of accessory muscles of ventilation
Tracheal tug
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7
Q

What is the management of stridor?

A

This is a medical emergency and should be approached using the ABCDE algorithm. The airway is not patent and this requires urgent action.

  • Give Oxygen or Heliox (mixture of oxygen and helium that is less dense and may reduce work of breathing)
  • Nebulised Adrenaline (1ml of 1:1000 with 1 ml saline- causes bronchodilatation)
  • Monitor O2 saturation, RR, HR,BP
  • Escalate and call for ENT/Anaesthetic senior ASAP
  • Be brief with history taking from patient or relative
  • Secure the airway by the least invasive method possible (intubation, cricothyroidotomy, tracheostomy)
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8
Q

How should the airway be managed if a patient presents with stridor?

A
  • Endotracheal intubation (1st line, move on if not possible)
  • Emergency Needle Cricothyroidotomy- If child less than 12 years of age (Very temporary procedure, only sustains life for 30-45 minutes)
  • Surgical Cricothyroidotomy
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9
Q

What is croup?

A

Also called acute laryngotracheobronchitis

Leading cause of stridor (if severe) involving inflammation of the larynx, trachea and bronchioles

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10
Q

What is the main cause of croup?

A

Viral (95%)- Parainfluenza virus, Respiratory Syncytial virus

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11
Q

What age group is croup commonly seen in?

A

Children (<6 years of age)

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12
Q

What are the signs of croup?

A

Stridor
Barking cough
Hoarse voice
Infective signs

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13
Q

What are the worrying signs of croup?

A
Stridor at rest
Cyanosis
Low SaO2
Increasing RR
Increasing HR
Fatigue/Tiredness
Altered consciousness level
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14
Q

What is the treatment of croup?

A

If no stridor and mild can be treated at home
Prednisolone 1-2mg/kg PO or Dexamethasone 0.15mg/kg PO
If severe signs- Nebulised Adrenaline 1:1000
Failure to improve, repeat and refer to ITU

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15
Q

Why is softer stridor more worrying?

A

Stridor is due to airway obstruction reducing flow. The sound is due to the volume of flow. Reduced volume indicates poor ventilation.

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16
Q

What is acute epiglottitis?

A

Rapidly progressive inflammation of the epiglottis and adjacent tissues. It is a medical emergency as the inflammation can quickly cause airway obstruction

17
Q

How may children/adults present with acute epiglottitis?

A

Difficulty breathing
Swallowing difficulty
Drooling of saliva (as avoid swallowing due to pain)
Sore throat
Fever
Irritability
Muffled voice/crying (as pain created through talking due to inflammatory process)
Cough is absent
(Note- Relatively rare in children due to Hib vaccination, now more commonly presents in adults with severe sore throat and painful swallowing)

18
Q

What is the management of acute epiglottis?

A

Keep the patient upright
Do not try to visualise or examine the back of the throat (as this can cause laryngospasm and closure of the airway)
Escalate to an ENT/Anaesthetic Registrar
Diagnosis is made by laryngoscopy and the patient intubated and given dexamethasone and antibiotics
Surgical airway is intubation not possible

19
Q

What is laryngomalacia?

A

Main congenital abnormality of the larynx that is often noticeable within hours of birth
Excessive collapse and in-drawing of the supra-glotic airways during inspiration leading to airway obstruction
In 85% no treatment is needed and symptoms usually improve by 2 years old
Problems can occur with concurrent laryngeal infections or with feeding
Surgery can help in severe cases