Stridor-slides-2003-1231

Stridor-slides-2003-1231 - Stridor, Aspiration, and Cough...

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Stridor, Aspiration, and Stridor, Aspiration, and Cough in Children Cough in Children Frederick S. Rosen, MD Ronald W. Deskin, MD The University of Texas Medical Branch December 31, 2003
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Stridor: Introduction Stridor: Introduction Harsh, high-pitched, musical sound produced by turbulent airflow through partially obstructed upper airway Poiseuille’s Law: Resistance inversely proportional to radius to 4 th power Bernoulli’s Law: Pressure decreases as velocity increases, causing tendency to collapse
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Stridor: Introduction Stridor: Introduction Supraglottic obstruction: Inspiratory stridor (high-pitched) Extrathoracic trachea obstruction – includes glottis & subglottis: Biphasic stridor (intermediate pitch) Intrathoracic trachea obstruction: Expiratory stridor (wheeze) Stertor = Low-pitched inspiratory sound from nose/nasopharynx (snoring)
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Croup = most common cause of acute stridor Laryngomalacia = most common cause of congenital chronic stridor First step: Determine degree of distress Decreased intensity may indicate resolution or exhaustion
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Positional stridor: Laryngomalacia, micrognathia, macroglossia, vascular compression Optimal position: Prone with neck extended Weak Cry: Disorder of TVC’s or poor pulmonary function Hoarseness: Laryngeal lesion (Normal voice does NOT rule out laryngeal lesion)
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Passage of nasal catheter to determine patency: Oral airway will bypass choanal atresia Pierre-Robin sequence: Nasopharyngeal airway to temporize ALWAYS maintain high index of suspicion for foreign body (airway or esophagus)
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Transnasal flexible endoscopy in stable patients while awake; can also evaluate swallow
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Stridor: Imaging Stridor: Imaging Lateral and A/P neck films: Inspiration distends hypopharynx, places epiglottis in vertical position, and stretches A-E folds diagonal Barium swallow: Aspiration, posterior laryngeal cleft, TEF, vascular ring, non- radioopaque esophageal foreign body (Difficult to distinguish cleft vs. aspiration)
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Stridor: Imaging Stridor: Imaging
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Stridor: Imaging Stridor: Imaging
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Stridor: Imaging Stridor: Imaging Double aortic arch: Most common extrinsic compressive disorder – bilateral curvilinear indentations at level of T-4 Pulmonary artery sling: Compression of right mainstem & lower trachea – anterior indentation of upper thoracic esophagus on LATERAL projection Aberrant subclavian artery similar finding (less common)
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Stridor: Imaging Stridor: Imaging
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Stridor: Imaging Stridor: Imaging MRI: superior to angiography in diagnosis of vascular rings because images airway and vessels simultaneously Used as second line if Echo/plain films/barium swallow nondiagnostic because of sedation requirement
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This note was uploaded on 12/28/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Stridor-slides-2003-1231 - Stridor, Aspiration, and Cough...

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