Download Acute Inflammatory Upper Airway Obstruction

URT Obstruction
Objectives
Know and understand the aetiology and natural
history of the upper airway obstruction including
knowledge of common causative organisms.
 Be able to make a confident differential diagnosis
for the various causes of upper airway obstruction.
URT Obstruction
Objectives
 Be able to advise parents about how to care for a
child with upper airway obstruction.
 Know the management options available, including
drugs, oxygen and supportive therapy
Acute Inflammatory Upper Airway
Obstruction
 The cricoid cartilage encircles the airway
just below the vocal cords and defines
the narrowest portion of the upper
airway.
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croup
 Heterogeneous group of mainly acute and
infectious processes that are characterized
by a bark like or brassy cough and may be
associated with hoarseness, inspiratory
stridor, and respiratory distress.
Stridor ( Rasping)
 Harsh, high-pitched respiratory sound,
which is usually inspiratory but it can be
biphasic and is produced by turbulent
airflow; it is not a diagnosis but a sign of
upper airway obstruction
Laryngotracheobronchitis
Laryngotracheobronchitis refers to viral
infection of the glottic and subglottic
regions.
LTB : Etiology
 Viral agents account for most acute infectious upper
airway obstructions.
 The exceptions are diphtheria, bacterial tracheitis, and
epiglottitis.
 The parainfluenza viruses (types 1, 2, and 3) account for
≈75% of cases; influenza A and B, adenovirus, respiratory
syncytial virus and measles and rarely Mycoplasma
pneumoniae
LTB: Epidemiology
 Most patients with LTB are between the ages of 3
mo and 5 yr, with the peak in the 2nd yr of life.
Higher incidence in males; in the late fall and
winter.
 Recurrences are frequent ,decrease with growth of
the airway.
 15% have a strong family history of croup.
RTI
LTB: Clinical Features
 URTI with rhinorrhea, pharyngitis, cough, and
low-grade fever for 1–3 days before upper airway
obstruction become apparent.
 Then characteristic “barking” cough, hoarseness,
and inspiratory stridor.
 Most progress only as far as stridor and slight
dyspnea before they recover.
LTB: Physical examination
 Hoarse voice, coryza, inflamed pharynx, and a
slightly increased respiratory rate.
 Rarely ,nasal flaring, suprasternal, infrasternal, and
intercostal retractions; and continuous stridor.
 The child who is hypoxic, cyanotic, pale, or
obtunded needs immediate airway management.
LTB: Investigations
 LTB is a clinical diagnosis and does not require
a radiograph of the neck.
 Radiographs of the neck may show the typical
subglottic narrowing or “steeple sign” of
croup on the poster anterior view.
Acute Epiglottitis (Supraglottitis)
 This dramatic, potentially lethal condition is caused
by:
Haemophilus influenzae type-b Bacteria
Case History
This 5-year old girl developed a severe
sore throat, drooling of saliva, a high
fever and increasing difficulty breathing
over 8 h .
Case Hx.
 Epiglottitis was diagnosed and her
airway was guaranteed with a
nasotracheal tube.
 Antibiotics were started immediately .
 She made a full recovery.
Epiglottitis
Epilottitis: Clinical Features DDD
 Often, the otherwise healthy child suddenly develops a
sore throat and fever.
 Within a matter of hours, the patient appears toxic,
swallowing is difficult, and breathing is labored.
 Drooling is usually present and the neck is
hyperextended in an attempt to maintain the airway.
Epiglottitis : Diagnosis
 visualization of a large, “cherry red” swollen epiglottis by
laryngoscopy.
 In a patient in whom the diagnosis is certain or probable
based on clinical grounds, laryngoscopy should be
performed in a controlled environment such as an
operating room or intensive care unit.
 Classic radiographs of a child who has epiglottitis show the
“thumb sign ”
CROUP: DDx
 Bacterial tracheitis
 Retropharyngeal or peritonsillar abscess
 Foreign body
 Diphtheria
 Angioedema
CROUP:DDx
 Edema after endotracheal intubation
 Infectious mononucleosis
 Hypocalcemic tetany
 Trauma
 Malformations of the larynx.
 Early sign of asthma.
 Vocal cord dysfunction
 Accidental ingestion of very hot liquid
Acute Infectious Laryngitis
 Laryngitis is a common illness. Viruses cause most
cases; diphtheria is an exception .
 The onset is usually characterized by an upper
respiratory tract infection during which sore throat,
cough, and hoarseness appear.
 The illness is generally mild; respiratory distress is
unusual except in the young infant.
Spasmodic Croup
 Clinically similar to acute LTB , except that the
history of a viral prodrome and fever in the
patient and family are frequently absent.
 The cause is viral , allergic or psychological
Bacterial tracheitis
 Staphylococcus aureus is the most commonly isolated
pathogen.
 Moraxella catarrhalis, non-typable H. influenzae, and
anaerobic organisms have also been implicated.
 May be considered a bacterial complication of a viral
disease, rather than a primary bacterial illness.
URTOBST.Complications
 In 15% of patients with viral croup.
 Pneumonia, cervical lymphadenitis, otitis media.
 Meningitis or septic arthritis can occur in the course of
epiglottitis.
 Mediastinal emphysema and pneumothorax if
tracheotomy
 Toxic shock syndrome if associated with S. aureus.
Croup: Treatment
 The mainstay of treatment for children with croup is airway
management
 Most acute spasmodic croup or croup can be managed safely at
home
 Mist has been traditionally used to treat croup.
 Nebulized racemic epinephrine is an accepted treatment for
moderate or severe croup
 The effectiveness of oral corticosteroids in viral croup is well
established
Epiglottitis: Treatment
 Epiglottitis is a medical emergency and warrants
immediate treatment with an artificial airway
placed under controlled conditions, either in an
operating room or intensive care unit
 Ceftriaxone or cefotaxime for 7-10 days
Prognosis
 Untreated epiglottitis has a mortality rate of 6% in some
series.
 if the diagnosis is made and appropriate treatment is
initiated before the patient is moribund, the prognosis is
excellent.
 The outcome of LTB, laryngitis, and spasmodic croup is
also excellent.
WITH THE QUIZ
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Characteristics
Dysphagia
Preceding flu
Toxically ill
LTB
EPIGLOTTITIS