Upper airway compromise

Question 1

What area does Croup affect?

Answer 1

lower laryngeal area
Trachea
Bronchi (occasionally)

Question 2

Is Croup viral or bacterial?

Answer 2

Viral

Question 3

What viral infections can lead to Croup?

Answer 3

Parainfluenza, RSV, influenza, adenovirus

Question 4

how is croup spread?

Answer 4

droplet inhalation or by contact

Question 5

When is croup most commonly diagnosed?

Answer 5

Late fall and winter

Question 6

Describe the pathophysiology of croup

Answer 6

initial infection of nasal and pharyngeal mucosa that spreads to respiratory epithelium
infection leads to inflammation of those areas resulting in decreased air flow

Question 7

What is the narrowest portion of the pediatric airway?

Answer 7

cricoid cartilage

Question 8

How does Croup present clinically?

Answer 8

1. 1-3 day history of cold like symptoms
2. Low grade fever
3. Hoarse voice
4. Barking cough
5. Stridor

Question 9

What might you see on the CXR of a patient with croup?

Answer 9

Steeple sign

Question 10

How can croup be diagnosed?

Answer 10

Clinical diagnosis based on the presence of
1. Barking cough
2. Stridor
3. Steeple sign

Question 11

What are options for managing croup?

Answer 11

1. Supportive care
2. Humidified air/oxygen
3. Nebulized racemic epi
4. IV steroids
5. Heliox

Question 12

How long does it take for Croup to resolve?

Answer 12

Generally 3-7 days, but as long as 2 weeks

Question 13

Is epiglottitis the result of a bacterial or a viral infection?

Answer 13

bacterial infection

Question 14

When is epiglottitis generally seen?

Answer 14

in patients 2-5 years old

Question 15

Describe the pathophysiology of epiglottitis

Answer 15

result of a bacterial infection that causes acute inflammation of the supraglottic region

Question 16

What is the bacteria responsible for epiglottitis?

Answer 16

haemophilus influenzae

Question 17

How does epiglottitis alter breathing?

Answer 17

dysmorphic shape of the epiglottis in the narrowed supraglottic area acts as a ball-valve mechanism producing partial to complete airway obstruction

Question 18

What does epiglottitis cause?

Answer 18

significant increases in airway resistance and work of breathing

Question 19

How does epiglottitis present clinically?

Answer 19

1. Sore throat
2. High grade fever
3. Difficulty swallowing
4. Drooling
5. Tripoding

Question 20

What are the 4 D’s of epiglottitis?

Answer 20

Drooling, dysphagia, dysphonia, distress

Question 21

What can you look for on a CXR to confirm the presence of epiglottitis?

Answer 21

Thumb sign

Question 22

How is epiglottitis managed and treated?

Answer 22

Visualization of the airway to determine level of swelling
Closely monitoring patient
ICU admission
Airway stabilization

Question 23

What kind of ETT would be inserted in a patient with epiglottitis?

Answer 23

cuffless ETT

Question 24

What factors lead to foreign body aspiration?

Answer 24

Lack of molar teeth
curiosity and exploration
high distractibility when eating

Question 25

How might a foreign body aspiration present in the acute stages?

Answer 25

choking coughing Severe SOB Cyanosis Absent breath sounds

Question 26

How might a foreign body aspiration present within 24 hours?

Answer 26

Unilateral wheezing Cough Stridor Respiratory distress Cyanosis Voice/cry changes

Question 27

What might a foreign body aspiration look like in the later stages?

Answer 27

Fever persistent or recurrent cough wheezing PNA atelectasis lung abscess hemoptysis

Question 28

How are foreign body aspirations managed?

Answer 28

Dependent on patients clinical presentation emergent cricothyrotomy rigid brochoscopy specimen sample for proper antibiotic coverage