Stridor (peds): Difference between revisions

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{{Peds top}} [[stridor]].''
==Background==
*Stridor refers to harsh upper airway sounds, classically inspiratory
*A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation
==Clinical Features==
*Inspiratory stridor
**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)
**[[Croup]], metapneumovirus, [[aspirated foreign body|foreign body]], [[epiglottitis]]
*Expiratory stridor vs. [[wheezing]]
**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)
**[[Asthma]], [[bronchiolitis]]
==Differential Diagnosis==
==Differential Diagnosis==
{{Pediatric stridor DDX}}
{{Pediatric stridor DDX}}


==See also==
==Evaluation==
*Assess airway
**If unstable, see [[Difficult Airway Algorithm]], [[Intubation]] and consider surgical intervention/consultation
**If stable, consider imaging or direct visualization of larynx with fiberoptic scope or video laryngoscope [[GEMC:Airway Procedures]]
*CT of neck if mass/infection suspected
 
==Management==
*Treat underlying cause
 
==Disposition==
*Based on underlying cause
 
==See Also==
*[[Stridor]]
*[[Stridor]]
==External Links==


==References==
==References==
 
<references/>
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:ENT]]
[[Category:ENT]]
[[Category:Symptoms]]
[[Category:Symptoms]]

Revision as of 16:47, 1 July 2020

This page is for pediatric patients. For adult patients, see: stridor.

Background

  • Stridor refers to harsh upper airway sounds, classically inspiratory
  • A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation

Clinical Features

Differential Diagnosis

Pediatric stridor

<6 Months Old

  • Laryngotracheomalacia
    • Accounts for 60%
    • Usually exacerbated by viral URI
    • Diagnosed with flexible fiberoptic laryngoscopy
  • Vocal cord paralysis
    • Stridor associated with feeding problems, hoarse voice, weak and/or changing cry
    • May have cyanosis or apnea if bilateral (less common)
  • Subglottic stenosis
    • Congenital vs secondary to prolonged intubation in premies
  • Airway hemangioma
    • Usually regresses by age 5
    • Associated with skin hemangiomas in beard distribution
  • Vascular ring/sling

>6 Months Old

  • Croup
    • viral laryngotracheobronchitis
    • 6 mo - 3 yr, peaks at 2 yrs
    • Most severe on 3rd-4th day of illness
    • Steeple sign not reliable- diagnose clinically
  • Epiglottitis
    • H flu type B
      • Have higher suspicion in unvaccinated children
    • Rapid onset sore throat, fever, drooling
    • Difficult airway- call anesthesia/ ENT early
  • Bacterial tracheitis
    • Rare but causes life-threatening obstruction
    • Symptoms of croup + toxic-appearing = bacterial tracheitis
  • Foreign body (sudden onset)
    • Marked variation in quality or pattern of stridor
  • Retropharyngeal abscess
    • Fever, neck pain, dysphagia, muffled voice, drooling, neck stiffness/torticollis/extension

Evaluation

Management

  • Treat underlying cause

Disposition

  • Based on underlying cause

See Also

External Links

References