Terms in this set (14)
What is stertor?
What is it?
• Noisy breathing caused by partial obstruction of the respiratory tract above the larynx"
• It's like a dog is heavily snoring
What are the causes of stertor?
• Paratoid tumours
• Abscess in the deep tissues of the neck
• Oropharynx/oral cavity (Ie in downs where the tongue is big and can fall back, or when there's an under developed maxilla)
• Trauma (Sometimes the maxilla can become fractured and create a mobile segment)
• Inflammatory (Ie Ludwig angina, often related to dental work)
• Foreign body
• Neoplastic (Often creates heavy breathing and a 'hot potato' voice)
Stridor: What is it?
• Noisy breathing caused by partial obstruction of the respiratory tract at or below the larynx
• It sounds like something is acutely blocking the airway
What are the different types of stridor?
• Inspiratory: Supraglottis (Laryngeal obstruction)
• Expiratory: Small Bronch/bronchioles (Asthma)
o A foreign body can also cause expiratory stridor. It may catch you if you think they have asthma
• Biphasic: Glottis, subglottis
Congenital parts involved:
• Trachea and bronchi
• Laringo malasia (Where the larynx isn't wel supported by the surrounding muscles)
• Cystic hydroma
• Subglottic stenosis (Can be congenital in babies, and it's difficult to intubate them.
• Trachea and bronchii narrowing (ie tracheal stenosis)
o (Ie an inflamed epiglottis - epiglottitis)
o (Ie in blunt trauma or hanging, you get distorted anatomy and mucosal oedema)
• Foreign body
o (The longer you leave a foreign body the more inflamed it can become - they will have an expiratory stridor)
o (Ie papillomas and external tumours that depress the larynx)
o (Ie when you have surgery on the thyroid it's possible to damage the recurrent laryngeal nerve and cause unilateral or bilateral palsy. )
o They can put themselves into vocal cord spasm.. They always have normal sats.
o They can usually always do stuff.
o They're difficult patients to treat. If everything is normal
What are the progressive symptoms as an airway is blocked?
• Noisy breathing - stertor, stridor
• Increased respiratory rate
• Increased use of muscles (accessory, intercostal)
• Tracheal tug
• Difficulty in talking
• Nasal flaring
• Reduced respiratory rate (tiring)
• Cyanosis, reduced GCS
• Cardiorespiratory arrest
Possible investigations to consider
• Complete medical history
• Radiology is used in chronic cases but not in acute attacks
• Pulse oximetry
• Arterial blood gases
• CT scanning
• Virtual bronchoscopy
2. Cough, cry, voice
4. Bent over
1. Deviation of trachea
2. Masses, crepitation's in chest, face or neck
1. Chest, neck, oropharynx and nose
Medical management with a paediatric with stridor and an obstructed airway:
• Oxygen or heliox
• Nebulised adrenalin
• Steroids (Dexamethasone)
• Nebulised steroids
End stage: What to do?
What's the difference between stridor and stertor?
Supraglottis, glottis, subglottis or trachea
Low pitched snoring
Naso or oropharanx
What's the difference between stridor and a wheeze?
- Stridor predominantly resp. and larger airways, monophonic
- Wheeze is expiratory and obstructions to many smaller airway, polyphonic.