Upper Airway Flashcards
(39 cards)
Stridor
Primary airway noise in upper airway disease. Airflow is forced through a narrowed airway segment. Local area of low pressure creates a vacuum effect distal to the narrowing. Airway walls collapse and vibrate. Generates a high pitched sound. Most prominent symptom of airway obstruction in infants
Steeple sign
AP and lateral x-ray. Classic with CROUP (Laryngotracheobronchitis)
Thumb print sign
AP and lateral x-ray. Classic with EPIGLOTTITIS.
Definition/Etiology of Croup (Laryngotracheobronchitis)
- Infection involving subglottic airway, larynx, trachea and bronchi
- Most commonly caused by parainfluenza type 1 &type 2
- Less commonly caused by adenovirus, RSV, influenza type A and B, parable type 3
- Infrequently caused by Mycoplasma pneumoniae
Symptoms of Croup (Laryngotracheobronchitis)
Barky or brassy cough, inspiratory stridor, retractions, persistent low grade fever, worsens at night and on day 2-3, hoarseness, wheezing, prolonged expiratory phase, Frequently begins 12-48 hours after non-specific upper respiratory tract symptoms
**Typically symptoms are worse at night
Croup (Laryngotracheobronchitis) diagnostic studies
- Diagnosis generally baed on H&P
- Viral studies may be sent to identify pathogen
- Lateral neck X-ray. STEEPLE SIGN
Treatment of Croup (Laryngotracheobronchitis)
Dexamethasone as single dose outpatient. Maybe 24 hour dose inpatient. Racemic epinephrine but controversial due to ineffectiveness over time.
Etiology of Tracheitis
Haemophilus-influenza (H-flu), Strep pneumoniae
Symptoms of Tracheitis
Stridor, tripod position, dysphagia, drooling, high fever >103. Ill appearing. Toxic appearing.
Tracheitis diagnostic studies
Lateral neck xray- THUMB SIGN = Epiglottitis
Tracheitis Treatment
Broad spectrum antibiotics, such as ceftriaxone or clindamycin. Symptom management. Steroids (dexamethasone).
Foreign Body Etiology (age)
Toddler age or infant with older sibling
Foreign body Symptoms
Acute cough, onset of choking, difficulty breathing, cyanosis, severe wheezing and/or stridor
Foreign body diagnostic studies
Inspiratory films, fluoroscopic evaluation
Foreign body treatment
Caution with transport, as object could progress and obstruct airway. Surgical emergency for bronchoscopy in the OR
Laryngotracheomalacia Etiology (age)
Infant age, previous injury or intubation, presence of lesion. Differentiate from vascular ring
Laryngotracheomalacia Symptoms
Chronic stridor, mild respiratory distress with exertion or illness
Laryngotracheomalacia Diagnostic Studies
Direct visualization with bronchoscopy
Laryngotracheomalacia Treatment
If lesion, surgical removal or repair
Retropharyngeal Abscess Etiology
Most commonly affects children less than 3-4 years. Group A strep, oropharyngeal anaerobic bacteria, Staph aureus.
Abscess in the retropharyngeal space following trauma or primary infection
Most common in children 1-5 years
Infections are polymicrobial
Common pathogens include Strep pyogenes, Staph aureus and Haemophilus species
Retropharyngeal Abscess Symptoms
Fever, malaise, decreased oral intake, neck stiffness, torticollis, sore throat and neck pain, stridor, respiratory distress, dysphagia, muffled voice, vertical adenopathy, retropharyngeal bulge, drooling
History may include recent intubation, oral foreign object, dental procedure, infection of structure draining into retropharyngeal space
Retropharyngeal Abscess Diagnostic Studies
H&P
CMC w/ dif –> leukocytosis
Soft tissue neck x-ray, CT
Retropharyngeal Abscess Treatment
Avoid noxious stimuli
Supplemental oxygen
Assure secured airway
Incision and Drainage by ENT, Culture for ID if abscess >2cm and failure to improve on IV abx in 24 hrs
Peritonsillar Abscess Etiology
Adolescent age, most common with history of acute pharyngitis, Group A Strep and mixed oropharyngeal anaerobes
A local cellulitis that progresses first to phlegm, then abscess; suppurative adenines is most common
Infections are polymicrobial
Common pathogens include Strep pyogenes, Staph aureus and Haemophilus species
