Scribd
Upload
39 views17 pages

Asyiqien Adnan: Akmal

Uploaded by

marunvaris
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
39 views17 pages

Asyiqien Adnan: Akmal

Uploaded by

marunvaris
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 17

by Akmal Asyiqien Adnan

DEFINITION
• S t r i d o r is a harsh noise produced by turbulent
airflow through a partially obstructed airway at the
level of the supi a•qlottis, Rlottis, stibRlottis and/or

• It should be differentiated from s te r to r, which is


a lower-pitched, snoring-type sound
generated at the level of
the naso|»harynx, orot»1iai j nx &
occasionally supraglottis.
• Stridor is a symptom, not a diagnosis or disease,
and the underlying cause must be determined.
ENERAL RU
1. Inspii atory stridor suggests a
supragIoGis and obstruction.

2. Expiratoiy stridor implies


t r a c h e a l obstruction

3• Biphasic stridor suggests a


subgIoGis
obstruction.
Epiglotts

Cartilage
CAUSES OF ACUTE STRIDOR

• Acute laryngotracheobronchitis (croup)


• Acute epiglottitis (supraglottitis)
• Foreign body aspiration
• Allergic reaction
• Acute tracheiatis
CAUSES OF CHRONIC
STRIDOR
• Laryngomalacia
• Vocal vord paralysis
• Laryngeal cyst
• Laryngeal webs
• Posterior laryngeal cleñ
• Subglottic hemangiomas
• Laryngeal papilloma
CLINICAL APPROACH
• History

• Physical examination

• Investigation

• Management
HISTOR
•YAge of onset, duration, severity, progression,
precipitating events (crying, feeding)
• Quality and nature of ci;;'iilg
• Positioning ( prone, supine, sitting)
• Voice
• Associated s y m p t o m s (cough, aspiration,
difficulty feeding, drooling, sleep
disordered breathing)
• Elicit history of color cl1:inge, cyanosis,
respiratory effoH, and apnea to determine the
severity of stridor.
PERINATAL:

• M a t e r n a l endotracheal int+ibation use and


duration
• Congenital anomalies
• Developmental history
• Feeding and growth history should be
evaluated because significant airway obstruction
can lead to caloric waste, resulting in lack of or
slow weight gain and growth.
• Regiirgitation and spitting up could be a sign
of GER that can cause irritation of the mucosa
of the larynx and trachea that could lead to
edema and stridor.
• Systemic review — ENT, RS, CVS, GI,
CNS

• Past medical

• Family history

• Drugs history

• Social history
EXAMINATION
• Any procedures that may induce anxiety (throat
examination, venipuncture etc) should NOT
be undertaken as it may cause complete
airway obstruction.

• General look

• Vital signs

• Routine full examination (RS, CVS, GI etc)


INVESTIGATION
Laboratory Studies
• Pulse oximetry
• arterial blood gas

Imaging Studies
• AP & lateral radiographs of the neck and chest (steeple sign, thumb print
sign)
• Barium esophagram may be performed if vascular compression,
tracheoesophageal fistula, GER, or neurological dysfunction is suspected.
• Contrast-enhanced CT scanning can demonstrate mediastinal masses
or aberrant
vessels.
• MRI may be helpful in delineating lesions of the upper airway and
vascular anomalies.
• PH probe or barium swallow, If GER is suspected.

Other Tests
• Endoscopy
•
MANAGEMENT
Medical Care
• According to the underlying or predisposing condition.
Emergent management consists of ensuring that the airway is
adequate.
• If not, appropriate resuscitative measures must be initiated.

antibiotics, while stci•oids may be useful in other situations.

Surgical Care
• Severe laryngeal st‹u ‹)sis, critical tracheal stenosis,
laryngeal tracheal iii luck s and lesions
• )’’()1’el,gl4 l ()t1; aspiration, require surgical correction.
rJ“raclicotoniy is used to protect the airway to bypass laryngeal
abnormalities and stent or bypass tracheal abnormalities.
RL'i1(3{i1iai › ii cal and pci i fells illrii' alien L*-3 may have to be
dealt with
on an emergent basis.
• Moderate to severe stridor should be NPO in preparation for
CRO
U • Most common in 6m-3s
• Parainfluenza virus
• Barking cough, low-grade fever
• Stridor, hoarseness of voice
• Preceded by URTI

Steeple sign

Management :
-humidification of respiratory gases
-oxygen
-steroids
-nebulized epinephrine
EPiGL0TTiTi
•STypically in z-6y/o
• By H. Influenza
• High mortality rate
• Fever, difficulty in breathing,
severe odynophagia
• Muffled voice, inspiratory stridor

THUMB PRINT SIGN

Management:
-refer to ENT, Anest, Pediatrician
-transfer to room with tracheostomy
available
-IV a/biotic (ceftriaxone)

You might also like