Stridor Flashcards
(10 cards)
What are the primary actions in the management of stridor?
- Provide supplemental humidified oxygen and increase FiO₂ as needed.
- Monitor airway patency, quality of breathing, and hemodynamic stability.
- Consult the ASA Difficult Airway Algorithm for awake intubation and airway patency strategies.
- Maintain spontaneous respiration in patients with acute epiglottitis and supraglottitis.
- Use a smaller than normal diameter ETT to minimize tracheal edema in patients with laryngotracheobronchitis.
- Provide a calm, nonthreatening environment to prevent anxiety/agitation, which may worsen airway resistance.
- Secure IV access as the patient’s condition permits.
- Medical management of stridor (see Medications section).
What are the secondary actions in the management of stridor?
• Noninvasive supportive ventilation in adult patients (e.g., CPAP or BiPAP).
• If intubation is required, ensure ENT surgeon is present.
• Maintain spontaneous ventilation during airway management; consider awake intubation.
• Avoid neuromuscular blocking agents (can result in total airway obstruction).
• Extubation should only be performed in the OR after confirmed resolution of supraglottitis.
What medications are used for acute epiglottitis/supraglottitis?
• Glycopyrrolate: 2-4 mcg/kg IV bolus (antisialagogue).
• 4% Lidocaine Solution and 5% Lidocaine Paste for topical anesthesia for awake intubation (max dose 300 mg).
• Ketamine:
o 0.1-0.5 mg/kg IV for sedation and awake intubation in adults.
o 1-2 mg/kg IV for induction of anesthesia (if necessary).
• Antibiotics as appropriate.
What medications are used for laryngotracheobronchitis?
• Racemic Epinephrine (2.25% solution): 0.05-0.1 mL/kg (max dose 0.5 mL) nebulized in 2-3 mL normal saline.
• Dexamethasone: 0.25-0.5 mg/kg/dose IV (max daily dose 1.5 mg/kg/day).
• Heliox: Mixture of 70-80% helium and 20-30% oxygen.
What is stridor?
Stridor is a high-pitched inspiratory and expiratory sound caused by turbulent airflow through a partially obstructed airway.
What are the causes of stridor?
• Mechanical: Subglottic edema caused by ETT.
• Pathological: Inflammatory conditions such as epiglottitis or laryngotracheobronchitis.
What are the signs and symptoms of stridor?
Neurologic:
• Altered level of consciousness.
• Anxiety/agitation.
Respiratory:
• Cyanosis.
• Desaturation.
• High-pitched sound during inspiration and/or expiration.
• Hypercarbia.
• Hypoxia.
• Respiratory arrest.
• Substernal retractions.
• Tachypnea.
• Use of accessory muscles.
Cardiovascular:
• Bradycardia (late sign).
• Cardiac arrest.
• Hypertension (early sign).
• Hypotension (late sign).
• Tachycardia (early sign).
What is the differential diagnosis for stridor?
Respiratory:
• Airway edema after upper or lower airway surgery.
• Airway fire.
• Bacterial tracheitis.
• Craniofacial and airway abnormalities.
• Enlarged tonsils or adenoids.
• Foreign body aspiration.
• Functional laryngeal dyskinesia.
• Laryngeal neoplasm (e.g., papillomatosis).
• Laryngeal trauma (mechanical, chemical, thermal).
• Laryngospasm.
• Macroglossia.
• Peritonsillar abscess.
What are the differences between acute epiglottitis/supraglottitis and laryngotracheobronchitis in pediatrics?
Criteria Acute Epiglottitis/Supraglottitis Laryngotracheobronchitis
Airway Obstruction Supraglottic Subglottic
Onset of Symptoms Rapid (over 24 hours) Gradual (24-72 hours)
Pathological Cause Bacterial (Haemophilus influenzae) Viral infection
Age Group 2-6 years 6 months - 6 years
Radiograph Findings Enlarged epiglottis (thumbprint sign) Narrowing of subglottic area (pencil or steeple sign)
Laboratory Findings Neutrophilia Lymphocytosis
Respiratory Phase Inspiratory Inspiratory and expiratory
What diagnostic tests are used for assessing stridor?
Lateral cervical or chest radiograph to assess airway patency and identify obstruction.
