Stridor (peds): Difference between revisions
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{{Peds top}} [[stridor]].'' | |||
==Background== | |||
[[File:Cross section of a trachea and esophagus.png|thumb|Cross section of a trachea and esophagus anatomy.]] | |||
[[File:Blausen 0865 TracheaAnatomy.png|thumb|Tracheal anatomy.]] | |||
*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 | ==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]] |
Latest revision as of 19:41, 17 January 2024
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
- Inspiratory stridor
- Suggestive of extrathoracic obstruction (Pressuretrach < Pressureatm)
- Croup, metapneumovirus, foreign body, epiglottitis
- Expiratory stridor vs. wheezing
- Suggestive of intrathoracic obstruction (Pressuretrach < Pressurepleura)
- Asthma, bronchiolitis
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
- H flu type B
- 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
- 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