UPPER RESPIRATORY

TRACT OBSTRUCTION
CROUP
Croup
◦ Laryngotracheobronchitis
◦ the most common infection of the middle respiratory tract
◦ 6 months to 3 years
◦ Mostly in fall and winter
◦ parainfluenza viruses (types 1, 2, 3, and 4)
◦ RSV
◦ Insidious or spasmodic (probably allergic)
Clinical Manifestations
◦ barking or brassy cough
◦ Hoarseness
◦ inspiratory stridor
◦ low-grade
◦ Fever
◦ respiratory distress.
Clinical Manifestations
◦ Stridor
◦ a harsh, high-pitched respiratory sound : turbulent airflow
◦ usually inspiratory, may be biphasic
◦ a sign of upper airway obstruction.

◦ Wheezing may be present if there is associated lower airway involvement.

Laboratory tests
◦ Non-specific
◦ PCR
Differential Diagnosis
◦ Non infectious:
◦ Foreign body aspiration
◦ Vocal cord paralysis
◦ Laryngomalacia
◦ Subglottic stenosis

◦ Lesions needing laryngoscopy:

◦ Stridor in less than 4-month-old
◦ Positional stridor
◦ Stridor for longer than 1 week
Differential Diagnosis
◦ Infectious:
◦ Epiglottitis
◦ Bacterial Tracheitis
Treatment
◦ Keep the patient calm
◦ Corticosteroids (main)
◦ Dexamethasone oral or IM (0.6 mg/kg once)
◦ Or oral prednisolone
◦ Epinephrine
◦ For significant airway compromise
◦ Reduces subglottic edema by adrenergic vasoconstriction
Treatment
◦ Hospitalization:
◦ Cyanosis
◦ Stridor at rest
◦ Those receiving aerosol should stay for at least 2-3 hours
◦ Rebound airway obstruction
◦ Decreased symptoms may indicate:
◦ Improvement
◦ Or
◦ fatigue, and impending respiratory failure!!!!!
EPIGLOTTITIS
Epiglottitis
◦ A medical emergency: sudden airway obstruction
◦ Now rare
◦ Etiology
◦ Streptococcus
◦ Staphylococcus aureus
◦ Haemophilus influenzae type b in unimmunized patients
Clinical Manifestations
◦ Sniffing position
◦ Distressed and toxic
Diagnosis
◦ confirmed by direct observation of the inflamed
and swollen supraglottic structures
◦ swollen, cherry red epiglottitis
◦ Direct observation of the larynx only be
performed in the operating room
◦ an anesthesiologist and a competent surgeon
◦ prepared to place an endotracheal tube or
perform a tracheostomy if needed
Treatment
◦ Intubation to maintain the airway
◦ Antibiotic therapy
BACTERIAL TRACHEITIS
Bacterial Tracheitis
◦ Rare but serious superinfection of trachea
◦ May happen after croup
◦ Most commonly caused by S. aureus
◦ Toxic patients
◦ May require intubation
◦ Needs antibiotic therapy