Cardiac Output, Venous Return, and Their Regulation
Stridor Presentation
1. Defined: High-pitched noisy breathing caused by
turbulence from obstruction anywhere between nasal
or oral cavity to the bronchi (harsh, creaking sound)
Common in infants because of the small diameter of
their airways
Subtle abnormalities can cause obstruction in
newborns and infants
2. Inspiratory Stridor
Typically caused by obstruction at or above the level of
the vocal cords
Expiratory Stridor
Usually localized to the more distal tracheobronchial
tree
Biphasic Stridor
Usually caused by obstructions at the true vocal cords
3. Extrathoracic Airway Obstruction
Usually present with symptoms of obstruction
Hoarseness, brassy (“Barky”) cough, or stridor
Presence of agitation, air hunger, severe retractions,
cyanosis, lethargy require immediate intervention
Diagnostic evaluation should include chest and lateral
neck radiographs
5. Presentation
Staccato inspiratory stridor
Worse with exertion, feeding, crying
Noisy breathing generally begins at about 2-4 weeks of age
Endoscopic appearance
Omega epiglottis
Foreshortenend
aryepiglottic folds
Cuneiform prolapse
8. Inflammation of airway is present, but edema of the
subglottic space accounts for the predominant signs
of airway obstruction
Common, usually between ages 6 mos to 3 yrs
Boys>girls (3:2)
Seasonal – Fall and Winter
9. Causative Organisms
75% of cases are caused by Parainfluenza types 1, 2 & 3
RSV
Influenza A, B
Rubeola
Adenovirus
M. pneumoniae
Bacterial (pseudomembranous croup)
Severe and life-threatening
10. Classic presentation
Begins with URI symptoms (rhinorrhea, fever)
Hours to days later, sxs of upper airway obstruction
develop
Hallmark is hoarseness and a barking or “croupy” cough
(Seal bark) and inspiratory stridor
Mild-severe respiratory distress
Labored breathing, marked retractions
11. Diagnosis
Based primarily on history and exam
AP x-ray of the neck will show tapering subglottic
narrowing
“Steeple sign”
Not necessary to make diagnosis
12.
13. Prognosis
Most have uneventful course and improve in a few days
Recurrence can occur in some instances
Suggests airway hyperreactivity
15. TRUE MEDICAL EMERGENCY!
Inflammation of the epiglottis and adjacent structures
Incidence has decreased dramatically with HIB
vaccine
Most cases occur in children 1-5 yrs.
Boys>Girls (only slightly)
17. Presentation
Progression of illness more rapid than croup
Cough usually absent, high fever
Drooling, apprehension, dysphagia, respiratory distress,
and toxicity
Resist lying down
Classic “tripoding” posture
Sits upright with arms forward in front and neck extended to
maximize airway caliber
“Sniffing” position – head forward, jaw thrust forward, mouth
open
18. Diagnosis
Extreme care must be taken not to agitate the patient
or irritate the airway
Lateral x-ray of the neck
Thumb sign (rounded appearance of epiglottis)
Thickened aryepiglotic folds