16 Upper Airway

Croup

  • aka laryngotreacheobronchitis

  • path: parainfluenza

  • pt: 3 mo to 3 yrs

  • symptoms

    • prodrome progress to barking/seal like cough, stridor in between

  • diagnosis

    • xray: steeple sign, not very useful

    • Clinical

  • treatment

    • mild: misting and send home

    • moderate: racemic epi and steroids IM, O2 supplementation

    • severe: admit, ongoing racemic episode.,

Bacterial Tracheitis

  • path: staph aureus, following viral prodrome. The typical story is several days of viral upper respiratory symptoms, followed by an acute elevation of temperature and an increase in respiratory distress.

  • pt: 4 yo

  • symptoms

    • more endolent

    • croup does not improve with racemic epi or steroids

    • may have more toxicity (higher fever, glucocytosis)

    • biphasic stridor

  • diagnosis

    • steeple sign

    • racemic epi doesn't work

    • tracheal culture + maybe scope

  • treatment

    • IV antibiotics.,

Epiglottis

  • path: H. Flu, Hib vaccine prevents

  • pt: 3-7 yo

  • symptoms

    • rapid onset, high fever, very sick

    • tripoding, drooling (hurts on swallow), using accessory muscles

    • muffled voice

  • diagnosis

    • Xray thumbprint sign

    • visualize cherry red swollen epiglotitis

  • treatment: ET tube, antibiotics.,

Retropharyngeal Abscess

  • path: oral floral

  • symptoms: very sick, abrupt onset, high fever, drooling, extended neck, neck stiffness, muffled voice

  • diagnosis

    • anterior LAD, tender mass (abscess)

    • CT scan

  • treatment

    • I & D

    • IV antibiotics.,

Peritonsilar Abscess

  • path: oral floral

  • pt: adolescent, >10 yo

  • symptoms: muffled voice, sore throat, odynophagia, uvular deviation

  • diagnosis: clinical

  • treatment: I&D, IV antibiotics.,

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