Difference between revisions of "Stridor (peds)"

 
Line 16: Line 16:
  
 
==Evaluation==
 
==Evaluation==
 +
*Assess airway
 +
**If unstable, see [[Difficult Airway Algorithm]], [[Intubation]] and consider surgical intervention/consultation
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**If stable, consider imaging or direct visualization of larynx with fiberoptic scope or video laryngoscope [[GEMC:Airway Procedures]]
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*CT of neck if mass/infection suspected
  
 
==Management==
 
==Management==
 +
*Treat underlying cause
  
 
==Disposition==
 
==Disposition==
 +
*Based on underlying cause
  
==See also==
+
==See Also==
 
*[[Stridor]]
 
*[[Stridor]]
  

Latest 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

<6mo

  • Laryngotracheomalacia
    • Accounts for 60%
    • Usually exacerbated by viral URI
    • Dx w/ flexible fiberoptic laryngoscopy
  • Vocal cord paralysis
    • Stridor associated w/ feeding problems, hoarse voice, weak and/or changing cry
    • May have cyanosis or apnea if bilateral (less common)
  • Subglottic stenosis
    • Congenital vs 2/2 prolonged intubation in premies
  • Airway hemangioma
    • Usually regresses by age 5
    • Associated w/ skin hemangiomas in beard distribution
  • Vascular ring/sling

>6mo

  • 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
    • Sx 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