URT Obstruction Objectives Know and understand the aetiology and natural history of the upper airway obstruction including knowledge of common causative organisms.  Be able to make a confident differential diagnosis for the various causes of upper airway obstruction.

URT Obstruction Objectives Be able to advise parents about how to care for a child with upper airway obstruction. Know the management options available, including drugs, oxygen and supportive therapy

Acute Inflammatory Upper Airway Obstruction The cricoid cartilage encircles the airway just below the vocal cords and defines the narrowest portion of the upper airway.

croup Heterogeneous group of mainly acute and infectious processes that are characterized by a bark like or brassy cough and may be associated with hoarseness, inspiratory stridor, and respiratory distress.

Stridor ( Rasping) Harsh, high-pitched respiratory sound, which is usually inspiratory but it can be biphasic and is produced by turbulent airflow; it is not a diagnosis but a sign of upper airway obstruction

Laryngotracheobronchitis Laryngotracheobronchitis refers to viral infection of the glottic and subglottic regions.

LTB : Etiology Viral agents account for most acute infectious upper airway obstructions. The exceptions are diphtheria, bacterial tracheitis, and epiglottitis. The parainfluenza viruses (types 1, 2, and 3) account for ≈75% of cases; influenza A and B, adenovirus, respiratory syncytial virus and measles and rarely Mycoplasma pneumoniae

LTB: Epidemiology Most patients with LTB are between the ages of 3 mo and 5 yr, with the peak in the 2nd yr of life. Higher incidence in males; in the late fall and winter. Recurrences are frequent ,decrease with growth of the airway. 15% have a strong family history of croup.

RTI

LTB: Clinical Features URTI with rhinorrhea, pharyngitis, cough, and low-grade fever for 1–3 days before upper airway obstruction become apparent. Then characteristic “barking” cough, hoarseness, and inspiratory stridor. Most progress only as far as stridor and slight dyspnea before they recover.

LTB: Physical examination Hoarse voice, coryza, inflamed pharynx, and a slightly increased respiratory rate. Rarely ,nasal flaring, suprasternal, infrasternal, and intercostal retractions; and continuous stridor. The child who is hypoxic, cyanotic, pale, or obtunded needs immediate airway management.

LTB: Investigations LTB is a clinical diagnosis and does not require a radiograph of the neck. Radiographs of the neck may show the typical subglottic narrowing or “steeple sign” of croup on the poster anterior view.

Acute Epiglottitis (Supraglottitis) This dramatic, potentially lethal condition is caused by: Haemophilus influenzae type-b Bacteria

Case History This 5-year old girl developed a severe sore throat, drooling of saliva, a high fever and increasing difficulty breathing over 8 h .

Case Hx. Epiglottitis was diagnosed and her airway was guaranteed with a nasotracheal tube. Antibiotics were started immediately . She made a full recovery.

Epiglottitis

Epilottitis: Clinical Features DDD Often, the otherwise healthy child suddenly develops a sore throat and fever. Within a matter of hours, the patient appears toxic, swallowing is difficult, and breathing is labored. Drooling is usually present and the neck is hyperextended in an attempt to maintain the airway.

Epiglottitis : Diagnosis visualization of a large, “cherry red” swollen epiglottis by laryngoscopy. In a patient in whom the diagnosis is certain or probable based on clinical grounds, laryngoscopy should be performed in a controlled environment such as an operating room or intensive care unit. Classic radiographs of a child who has epiglottitis show the “thumb sign ”

CROUP :DDx Bacterial tracheitis Retropharyngeal or peritonsillar abscess Foreign body Diphtheria Angioedema

DDx:CROUP Edema after endotracheal intubation Infectious mononucleosis Hypocalcemic tetany Trauma Malformations of the larynx. Early sign of asthma. Vocal cord dysfunction Accidental ingestion of very hot liquid

Acute Infectious Laryngitis Laryngitis is a common illness. Viruses cause most cases; diphtheria is an exception . The onset is usually characterized by an upper respiratory tract infection during which sore throat, cough, and hoarseness appear. The illness is generally mild; respiratory distress is unusual except in the young infant.

Spasmodic Croup Clinically similar to acute LTB , except that the history of a viral prodrome and fever in the patient and family are frequently absent. The cause is viral , allergic or psychological

Bacterial tracheitis Staphylococcus aureus is the most commonly isolated pathogen. Moraxella catarrhalis, non-typable H. influenzae, and anaerobic organisms have also been implicated. May be considered a bacterial complication of a viral disease, rather than a primary bacterial illness.

URTOBST.Complications In 15% of patients with viral croup. Pneumonia, cervical lymphadenitis, otitis media. Meningitis or septic arthritis can occur in the course of epiglottitis. Mediastinal emphysema and pneumothorax if tracheotomy Toxic shock syndrome if associated with S. aureus.

Croup: Treatment The mainstay of treatment for children with croup is airway management Most acute spasmodic croup or croup can be managed safely at home Mist has been traditionally used to treat croup. Nebulized racemic epinephrine is an accepted treatment for moderate or severe croup The effectiveness of oral corticosteroids in viral croup is well established

Epiglottitis: Treatment Epiglottitis is a medical emergency and warrants immediate treatment with an artificial airway placed under controlled conditions, either in an operating room or intensive care unit Ceftriaxone or cefotaxime for 7-10 days

Prognosis Untreated epiglottitis has a mortality rate of 6% in some series. if the diagnosis is made and appropriate treatment is initiated before the patient is moribund, the prognosis is excellent. The outcome of LTB, laryngitis, and spasmodic croup is also excellent.

GOOD LUCK

GOOD LUCK WITH THE QUIZ

Mark +ve or -ve EPIGLOTTITIS LTB Characteristics Dysphagia Preceding flu Toxically ill