1. Pediatric Advanced Life Support
“UPPER AIRWAY”
Presented By: Mike Pyorala, RCP

2. UPPER AIRWAY
The portion of the respiratory tract that extends from the nostrils or mouth through the larynx.

3. UPPER AIRWAY

4. UPPER AIRWAY

5. UPPER AIRWAY

6. UPPER AIRWAY

8. Airway must be clear and patent for successful ventilation.
Position
Clear of foreign body
Free from injury .

9. UPPER AIR OBSTRUCTION
UPPER AIRWAY OBSTRUCTION IS A COMMON CAUSE OF PEDIATRIC EMERGENCY DEPARTMENT VISITS, ACCOUNTING FOR APPROXIMATELY 15% OF ALL CRITICALLY ILL PATIENTS
INFECTIOUS ETIOLOGIES ACCOUNT FOR 90% OF THESE, WITH VIRAL CROUP ACCOUNTING FOR 80%

10. COMMON PEDIACTRIC UPPER AIR OBSTRUCTIONS
CROUP
EPIGLOTTITIS

11. CROUP CROUP AKA: LARYNGOTRACHEOBRONCHITIS VIRAL
MOST COMMON CAUSE OF UPPER AIRWAY OBSTRUCTION
TRANSMITTED VIA RESPIRATORY ROUTE. PORT OF ENTRY: NOSE & NASOPHARYNX

12. CROUP FIRST FEW DAYS- MILD URI, NASAL CONGESTION, COUGH, SORE THROAT
EDEMA SPREADS AS INFECTION SPREADS
HOARSE VOICE & HARSH BARK LIKE COUGH DEVELOPS
STRIDOR USUALLY DEVELOPS AT NIGHT

13. CROUP ELEVATED TEMPERATURE MAY HAVE EXPIRATORY WHEEZING
INSPIRATORY STRIDOR AT REST, NASAL FLARING, RETRACTIONS

14. CROUP TREATMENT: HUMIDIFIED AIR OR OXYGEN STERIODS ALBUTEROL
RACEMIC EPINEPHRINE- MAX EFFECT SEEN IN 30 MIN, REBOUND IN 2 HOURS

15. EPIGLOTTITIS AKA: SUPRAGLOTTITIS OCCURS IN 3-7 YEARS OF AGE
BACTERIAL INFECTION- HEMOPHILUS INFLUENZAE
1985 VACCINE, BUT VIRUS HAS MUTATED

16. EPIGLOTTITIS
EPIGLOTTITIS, VOCAL CORDS, SUPRAGLOTTIC STRUCTURES BECOME INFLAMMED AND EDEMATOUS
NARROWED AIRWAY
RESPIRATORY COMPROMISE
INSPIRATORY AIR OCCLUSION NORMALLY OCCURS PRIOR TO TOTAL OCCLUSION

17. EPIGLOTTITIS MAY ALSO BE CAUSED BY: HOT LIQUIDS FOREIGN BODY INGESTION
INHALATION INJURIES

18. EPIGLOTTITIS SYMPTOMS: VERY SUUDEN ONSET, RAPID PROGRESSON
MUFFLED VOICE OR CRY
MINIMAL COUGH
FEVER
SORE THROAT
DROOLING

19. REVIEW EPIGLOTTITIS CROUP VOICE- MUFFLED VOICE- HOARSE
COUGH- USUALLY NONE
FEVER- YES
SALIVA- LOTS
NECK SWELLING- LOTS
CROUP
VOICE- HOARSE
COUGH- BARKING
FEVER- YES
SALIVA- MINIMAL
NECK SWELLING- MINIMAL

20. REVIEW CROUP EPIGLOTTITIS BEGINS SUDDENLY BEGINS- SLOWLY
SEASON- AUTUMN
TIME- EVENING / NIGHT
EPIGLOTTITIS
BEGINS SUDDENLY
SEASON- ALL YEAR
TIME- ALL DAY

21. Respiratory Arrest
Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.
Only 10% of children who progress to cardiopulmonary arrest are successfully resuscitated.

22. EPIGLOTTITIS SYMPTOMS: RETRACTIONS
NOISY, HIGH PITCHED SQUEAKY INHALATIONS
CYANOSIS
ODD HEAD POSTURE (SNIFFING POSITION)

23. EPIGLOTTITIS
WHAT CAUSES AIRWAY OBSTRUCTION?

24. EPIGLOTTITIS WHAT CAUSES AIRWAY OBSTRUCTION? FATIGUE LARYNGOSPASM
POOLED SECRETIONS
PROGRESSIVE SWELLING OF SUPRAGLOTTIC STRUCTURES

25. EPIGLOTTITIS TREATMENT: AIRWAY MANAGEMENT
HIGH FLOW HUMIDIFIED OXYGEN TO MAINTAIN SATURATION
POSITIONOF COMFORT
NOISY, HIGH PITCHED SQUEAKY INHALATIONS
CYANOSIS
ODD HEAD POSTURE (SNIFFING POSITION)
HOT LIQUIDS
FOREIGN BODY INGESTION
INHALATION INJURIES

26. REVIEW EPIGLOTTITIS CROUP VOICE- MUFFLED VOICE- HOARSE
COUGH- USUALLY NONE
FEVER- YES
SALIVA- LOTS
NECK SWELLING- LOTS
CROUP
VOICE- HOARSE
COUGH- BARKING
FEVER- YES
SALIVA- MINIMAL
NECK SWELLING- MINIMAL

27. REVIEW CROUP EPIGLOTTITIS BEGINS SUDDENLY BEGINS- SLOWLY
SEASON- AUTUMN
TIME- EVENING / NIGHT
EPIGLOTTITIS
BEGINS SUDDENLY
SEASON- ALL YEAR
TIME- ALL DAY

28. Respiratory Arrest
Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.
Only 10% of children who progress to cardiopulmonary arrest are successfully resuscitated.

29. Pediatric Advanced Life Support
THANK YOU !
Pediatric Advanced Life Support
“UPPER AIRWAY”
Presented By: Mike Pyorala, RCP