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Stridor in children

Assessment of Stridor in Children- CJ- 1/8/2013

Explain how stridor is produced Areas of low pressure distal to narrowed airways cause airway to collapse and vibrate
Stridor is described as A high pitched, musical sound made while breathing
What is the narrowest part of the trachea? Subglottis
Croup, epiglottitis, retropharyngeal abscess and diphtheria all cause Extrathoracic obstructions
The supraglottic area includes the Nasopharynx, epiglottis, larynx, aryepiglottic folds and false vocal cords
The upper airway is divided into two regions, they are Extrathoracic and intrathoracic
What is the most common cause of extrathoracic airway obstruction in infants? Croup (Laryngomalacia)
Larynogomalacia is commonly known as Croup
Stridor from extrathoracic obstruction is heard in Inspiration
Stridor from intrathoracic obstruction is heard in Expiration
Stridor heard in both inspiration and expiration is coming from Glottis or a fixed and critical obstruction
Narrowing of nasal, nasopharyngeal or oropharyngeal areas leads to Snoring
Stridor in a patient ages birth-toddler, Consider a Congenital disorder
Stridor in 6-36months, consider Croup or foreign body aspiration
Stridor in less than 4 years old, consider Retropharyngeal abscess
Stridor in older than 10, consider Peritonsillar abscess
In abrupt onset stridor, consider Allergic reaction, foreign body or infection
If patient presents with respiratory distress+drooling+gasping+fever, consider Bacterial tracheitis (Emergency)
If stridor presents with a steady, progressive onset, consider Viral croup (90% of stridor!!)
Delayed airway burns can result from Steam, smoke, or microwaved liquids (Emergency)
In chronic stridor, consider Foreign body, tumor, subglottic stenosis, or vascular rings
If patient presents with a change in voice, consider Laryngeal lesion or paralysis
Evaluate the patient 2 times Rest and after
Which factors are important to inspect for a stridor patient Height/weight, size of tonigue, craniofacial malformation, surgical scars, neck edema, fever, cyanosis, nasal flaring, retractions, lymphadenopathy, clubbing, hemangiomas, cafe au lait spots
Which side of the stethoscope to use for stridor The bell
In a patient with a steeple sign, consider Croup
What radiographic test is give to a patient with an intrathoracic problem? Chest xray
What radiographic test is given to a patient with swallowing problems? Barium swallow
What radiographic test is given to a patient with tracheomalacia Airway fluoroscopy
What radiographic test is given to a patient with mediastinum, tracheal stenosis or obstruction MRI
what test will give a definitive diagnosis for epiglottitis or bacterial tracheitis? Airway exam
What scope would you use for a stable airway? Nasopharyngoschopy
What scope would you use for an unstable airway? Laryngoscopy or bronchoscopy
Gold standard scope for subglottic, tracheal and central airway lesions, biopsies, foreign bodies, and to dilate stenosed airways Rigid laryngoscopy
Extrathoracic obstructions are found Above the thoracic inlet (Supraglottic, glottic and subglottic area)
Intrathoracic obstructions are found in The portion of the trachea in the thoracic cavity and the mainstem bronchi
Created by: mcasto