Stridor: Difference between revisions

Latest revision as of 16:48, 1 July 2020

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

Background

Stridor refers to harsh upper airway sounds, classically inspiratory

Clinical Features

Inspiratory stridor
- Suggestive of extrathoracic obstruction (Pressure_trach < Pressure_atm)
- foreign body, epiglottitis
Expiratory stridor vs. wheezing
- Suggestive of intrathoracic obstruction (Pressure_trach < Pressure_pleura)
- Asthma

Differential Diagnosis

Stridor

Trauma

Larynx fracture
Tracheobronchial tear/injury
Thyroid gland injury/trauma
Tracheal injury
Electromagnetic or radiation exposure
Burns, inhalation injury

Infectious Disorders

Bacterial tracheitis
Diphtheria
Tetanus
Tracheobronchial tuberculosis
Poliomyelitis, paralytic, bulbar, or acute
Fungal laryngitis

Abscesses

Neoplastic Disorders

Neoplasms/tumors

Allergic and Auto-Immune Disorders

Spasmodic/tracheobronchitis
Angioedema/Angioneurotic edema

Metabolic, Storage Disorders

Cerebral Gaucher's of infants (acute)
Tracheobronchial amyloidosis

Biochemical Disorders

Tetany

Congenital, Developmental Disorders

Angioedema/Angioneurotic edema, hereditary

Psychiatric Disorders

Somatization disorder

Anatomical or Mechanical

Foreign body aspiration
Acute gastric acid/aspiration syndrome
Airway obstruction
Neck compartment hemorrhage/hematoma
Paradoxical vocal fold motion ^[1]

Vegetative, Autonomic, Endocrine Disorders

Esophageal free reflux/GERD syndrome
Laryngospasm, acute
- Bilateral vocal cord paralysis
Hypoparathyroidism

Poisoning

Chronic Pediatric Conditions

Laryngotracheomalacia^[2]
Subglottic stenosis or prior intubation
Vascular ring (double aortic arch)
Vocal cord dysfunction/paroxysmal vocal fold movement

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

External Links

References

↑ Vocal Cord Dysfunction on Internet Book of Critical Care https://emcrit.org/ibcc/vcd/
↑ Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004

Authors:

[1] Vocal Cord Dysfunction on Internet Book of Critical Care https://emcrit.org/ibcc/vcd/

[2] Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004

[1]

[2]

@@ Line 1: / Line 1: @@
-Trauma Causes
+{{Adult top}} [[stridor (peds)]].''
+==Background==
+*Stridor refers to harsh upper airway sounds, classically inspiratory
-          o Larynx fracture
+==Clinical Features==
+*Inspiratory stridor
+**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)
+**[[Aspirated foreign body|foreign body]], [[epiglottitis]]
+*Expiratory stridor vs. [[wheezing]]
+**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)
+**[[Asthma]]
-          o Tracheobronchial tear/injury
+==Differential Diagnosis==
+{{Stridor DDx}}
-          o Thyroid gland injury/trauma
+==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
-          o Trachea injury
+==Management==
+*Treat underlying cause
-Electromagnetic, Physics, trauma, Radiation Causes
+==Disposition==
+*Based on underlying cause
-          o Burn, inhalation
-Iatrogenic, Self Induced Disorders
-          o Mechanical ventilation status
-Infectious Disorders (Specific Agent)
-          o Bacterial tracheitis
-          o Diphtheria
-          o Tetanus
-          o Tracheobronchial tuberculosis
-          o Poliomyelitis, paralytic, bulbar
-          o Poliomyelitis, acute
-          o Fungal Laryngitis
-Infected organ, Abscesses
-          o Abscess, parapharyngeal
-          o Epiglottitis, acute
-          o Peritonsillar abscess
-          o Laryngotracheobronchitis, acute
-          o Abscess, retropharyngeal
-Neoplastic Disorders
-          o Neoplasms/tumors
-Allergic, Collagen, Auto-Immune Disorders
-          o Croup, spasmodic/tracheobronchitis
-          o Angioedema/Angioneurotic edema
-Metabolic, Storage Disorders
-          o Cerebral Gaucher's of infants (acute)
-          o Tracheobronchial amyloidosis
-Biochemical Disorders
-          o Tetany
-Congenital, Developmental Disorders
-Hereditary, Familial, Genetic Disorders
-          o Angioedema/Angioneurotic edema, hereditary
-Relational, Mental, Psychiatric Disorders
-          o Somatization disorder
-Anatomic, Foreign Body, Structural Disorders
-          o Acute gastric acid/aspiration syndrome
-          o Airway obstruction
-          o Neck compartment hemorrhage/hematoma
-Vegetative, Autonomic, Endocrine Disorders
-          o Esophageal free reflux/GERD syndrome
-          o Laryngospasm, acute
-          o Bilateral vocal cord paralysis
-          o Hypoparathyroidism
-Poisoning (Specific Agent)
-          o Smoke inhalation
-          o Chemical burn/esophagus
 ==See Also==
+*[[Stridor (Peds)]]
+==External Links==
-Peds: Stridor
+==References==
+<references/>
-[[Category:Airway/Resus]]
+[[Category:Critical Care]]
+[[Category:ENT]]
+[[Category:Symptoms]]