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EPIGLOTTITIS and CROUP

EPIGLOTTITIS and CROUP. Basic Science. Venturi effect Bernoulli principle turbulence è stridor. Bernoulli's Principle.

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EPIGLOTTITIS and CROUP

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  1. EPIGLOTTITIS and CROUP

  2. Basic Science • Venturi effect • Bernoulli principle • turbulence è stridor

  3. Bernoulli's Principle • as the speed of moving air increases, the pressure within the air decreases. When airflow is forced through a narrowed tube, a local area of low pressure creates a vacuum effect distal to the narrowing. The focal area of low pressure distal to a narrowed airway causes the airway walls to collapse and vibrate, generating the squeak characteristic of stridor

  4. Basic Science • glottis • supraglottic • subglottic • intrathoracic trachea

  5. Basic Science • pedi airway narrowest at subglottis • cross-section of airway proportional to square of radius (r2)

  6. Supraglottitis- Epiglottitis • “angina epiglottidea anterior” • bacterial cellulitis of supraglottis • 2 to 7 years old • Haemophilus influenzae type B most common • incidence greatly decreased since vaccine

  7. Supraglottitis • odynophagia • fever • irritability • stridor • rapidly progressive

  8. Supraglottitis • if suspected, diagnose by direct laryngoscopy in OR • lateral neck film - “thumb sign” • 1nasotracheal intubation • IV antibiotics • extubate when air leak noted - usually within 48 hours

  9. Laryngotracheobronchitis • croup - Scottish for barking cough • 6 months to 3 years old • Parainfluenza viruses types 1 and 2 most common

  10. Laryngotracheobronchitis • URI symptoms • barking cough • hoarseness • inspiratory stridor • low-grade fever

  11. Laryngotracheobronchitis • laryngoscopy for those with respiratory distress • AP neck - “steeple sign” • supraglottis normal

  12. Laryngotracheobronchitis • usually self-limited • humidified air • racemic epinephrine • steroids • heliox • intubation for severe, refractory cases

  13. Spasmodic Croup • presentation similar to LTB • sudden onset stridor • afebrile • recurrent episodes that resolve spontaneously • unknown cause

  14. Case Study 1 • 14 month old male • breathing difficulties • 2-3 days of URI symptoms • this morning, cough and loud breathing sound

  15. Case Study 1 • afebrile, respirations 26/min, pulse 124 beats/min • reclining in mother’s lap, NAD • soft, biphasic stridor • lungs clear to auscultation

  16. Case Study 1 • laryngotracheobronchitis • differential: epiglottitis, bacterial tracheitis, foreign body, subglottic stenosis

  17. Case Study 1 • lateral airway film - neck extended, inspiratory • racemic epinephrine • oral dexamethasone

  18. Case Study 1 • observe for 3 hours • vastly improved at 4 hours post-treatment • consider direct laryngoscopy and bronchoscopy in 3-4 weeks

  19. Case Study 2 • 6 year old • rhinorrhea, cough, low grade fever • acute onset high fever and stridor

  20. Case Study 2 • to OR for endoscopy • edematous larynx • ulceration and sloughing of tracheal mucosa • purulent secretions in right lower lobe

  21. Case Study 2 • nasotracheal intubation • IV Cefuroxime • S. aureus • CXR with right lower lobe pneumonia • extubated 4th day post intubation

  22. Controversies and Future • drastic decrease in supraglottitis as a result of vaccine • nasotracheal intubation for supraglottitis • disposition of children treated for LTB with epinephrine • steroids in LTB

  23. Conclusion • cause of much morbidity in pediatric population • potentially life-threatening • prompt diagnosis • assure adequate airway

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