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Stridor

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?
• Tongue
• Pharynx
• Tonsils
• Uvula
• Paratoid tumours
• Abscess in the deep tissues of the neck
Aetiology: Congenital
• Nose
• Nsaopharynx
• Oropharynx/oral cavity (Ie in downs where the tongue is big and can fall back, or when there's an under developed maxilla)
Aetiology: Acquired
• Trauma (Sometimes the maxilla can become fractured and create a mobile segment)
• Inflammatory (Ie Ludwig angina, often related to dental work)
• Foreign body
• Allergy
• 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
Aetiology: Conginital
Congenital parts involved:
• Supraglottis
• Glottis
• Subglottis
• Trachea and bronchi
Congenital conditions:
• 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)
Aetiology: Acquired
• Inflammatory
o (Ie an inflamed epiglottis - epiglottitis)
• Trauma
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)
• Allergy
• Neoplastic
o (Ie papillomas and external tumours that depress the larynx)
• Iatrogenic
o (Ie when you have surgery on the thyroid it's possible to damage the recurrent laryngeal nerve and cause unilateral or bilateral palsy. )
• Psychogenic
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

Croup!
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
• Tachycardic
• Sweating
• 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
Inspection/palpation/auscultation findings?
A. Observe
1. Drooling
2. Cough, cry, voice
3. Fever
4. Bent over

B. Palpate
1. Deviation of trachea
2. Masses, crepitation's in chest, face or neck

C. Auscultate
1. Chest, neck, oropharynx and nose
Medical management with a paediatric with stridor and an obstructed airway:
1:
• Oxygen or heliox
2:
• Nebulised adrenalin
• Steroids (Dexamethasone)

4:
• Nebulised steroids
3:
• Intubate


End stage: What to do?
• Cricothyroidotomy
• Mini-trach
• Trachy
What's the difference between stridor and stertor?
Stridor:
High pitched
Supraglottis, glottis, subglottis or trachea

Stertor
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.
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