Stridor and Sleep Apnoea Flashcards
What is stridor?
Predominantly inspiratory wheeze due to large airway (larynx, trachea, major bronchi) obstruction (wheeze is an expiatory noise)
Causes of stridor in children?
Infections (croup, epiglottitis, pseudomembranous croup, retropharyngeal abscess, diphtheria, infectious mononucleosis)Foreign bodyAnaphylaxis/ angioneurotic oedemaOther e.g. burn
What is croup?
Inflammation of the larynx and trachea in children
Causes of stridor in adults?
Neoplasms (larynx, trachea, major bronchi)AnaphylaxisGoitreTraumaOther e.g. bilateral vocal cord palsy
Investigations of stridor? (4)
Laryngoscopy (beware in acute epiglottitis)BronchoscopyFlow volume loopChest x-ray (other imaging e.g. CT)
Treatment of laryngeal obstruction?
Treatment of underlying cause e.g. foreign body removal, anaphylaxisMask bag ventilation with high flow O2CricothroidotomyTracheostomy
Treatment of malignant airway obstruction?
Tumour removal (laser, photodynamic therapy, cryotherapy, diathermy, surgical resection)Tumur compression e.g. intraluminal stent (if tumour out with the airway)RadiotherapyChemotherapy
What type of hypersensitivity reaction is acute anaphylaxis?
Type 1 (immediate) hypersensitiviy IgE
What is the name for swelling of the mouth, etc. during anaphylaxis?
Angioneurotic oedema
Why does anaphylaxis cause hypotension?
Vasodilation and plasma exudation
Treatment of anaphylaxis?
IV adrenaline (epinephrine)IV anti-histamineIV corticosteroidHigh flow O2Nebulised bronchodilatorEndotracheal intubation if necessary
What scale can be used to assess a patients sleepiness and therefore likelihood to have sleep apnoea?
Epworth sleepiness scale = normal = score of less than 10
What is snoring?
Relaxation of pharyngeal dilator muscles during sleep leading to upper airway narrowing, turbulent airflow and vibration of soft palate and tongue base
What is sleep apnoea?
An extension of snoring where the throat gets so relaxed that it flops all the way in causing of obstruction of upper airways - O2 levels will dip after the apnoea as by the time they dip you are breathing again (in brief it is intermittent upper airway obstruction in sleep)
What are risk factors for sleep apnoea?
Enlarged tonsils/ adenoidsObesityRetrognathia (abnormal posterior positioning of the mandible)Acromegaly, hypothyroidismOropharyngeal deformityNeutrological conditions such as MSDrugs e.g. opiates, alcoholPost-operative period after anaesthesia
