{"id":5345,"date":"2011-07-14T20:25:40","date_gmt":"2011-07-14T20:25:40","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5345.htm\/"},"modified":"2011-10-02T19:52:27","modified_gmt":"2011-10-02T19:52:27","slug":"upper-airway-obstruction-infections","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/medical-surgical\/upper-airway-obstruction-infections.htm\/","title":{"rendered":"Upper Airway Obstruction and Infections"},"content":{"rendered":"

 <\/p>\n

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<\/h2>\n

<\/span>Other infections found in Adult Section<\/a><\/span><\/h2>\n

<\/h2>\n

<\/span>Croup (Laryngotracheal Bronchitis)<\/span><\/h2>\n

Most common URI in children<\/p>\n

Etiology<\/p>\n

Parainfluenza type 1 is most common, but also type 2, 3 or RSV, influenza, mycoplasma (only after the toddler age)<\/p>\n

Classically children aged 1-3<\/p>\n

1-3 day history of URI, symptoms wax and wane over a week\u0092s time.\u00a0 Barking seal-like cough.\u00a0 Usually low grade fever, but it can be high grade<\/p>\n

Management<\/p>\n

Do not need labs, ABG or x-ray<\/p>\n

Start with cool mist does nothing but reassure parents and perhaps placebo (Acad Emerg Med 9(9):873 September 2002)<\/p>\n

Then steroids 0.6 mg\/kg of decadron (.15-.3 mg\/kg have been shown to be as effective) IM or PO.\u00a0 Also can use inhaled budesonide, which also might be helpful in addition to decadron.\u00a0 (Ann Emerg Med 30(3):353, September 2002)<\/p>\n

Epinephrine L or racemic should be given if still in distress.\u00a0 Dose of racemic is .5 cc in 3 cc of NS or dose of L-epi, 5 cc of 1:1000 nebulized.\u00a0\u00a0\u00a0 Observe for three hours after epi for rebound.\u00a0 Five R\/C studies show efficacy and no rebound after 3 hours. L and racemic have same effect.<\/p>\n

Admission Criteria<\/p>\n

Stridor at rest after steroids, epi, and 3 hrs observation.\u00a0 Patients requiring O2 to maintain, resp failure, tachypnea >60 after therapy.\u00a0 Pt looks toxic.\u00a0 If patient appears to require intubation, can try heliox as last ditch attempt to avoid.<\/p>\n

<\/span>Bacterial Tracheitis<\/span><\/h2>\n

Pseudomembranous croup.\u00a0 Consider in patients who appear to have croup, but do not improve with treatment.\u00a0 Patients also have profuse secretions and severe toxicity.<\/p>\n

Sloughing of epithelial lining causes problems with airway management.\u00a0 May see ragged trachea on x-ray.\u00a0 85% of patients will require endotracheal intubation.\u00a0 Usually occurs with superinfection of staph aureus, strep pneumoniae, moxarella, or H. Flu (now rare)<\/p>\n

<\/span>Epiglottitis<\/span><\/h2>\n

Supraglottic cellulitis from Group A B-Hemolytic Strep, but also S. Pneumo or Staph Aureus, though traditionally, H. Flu was the culprit.<\/p>\n

Can involve the pharynx as well as the supraglottic tissues<\/p>\n

Sick and toxic with dysphagia.\u00a0 Drooling, tripod position, muffled voice, and no coughing.\u00a0 Portable lateral neck x-ray only if Dx is unclear.\u00a0 Give Cefotaxime (50 mg\/kg Q6) and oxacillin.<\/p>\n

<\/span>Retropharyngeal Abscess<\/span><\/h2>\n

uncommon after five years old<\/p>\n

can track to mediastinum or carotid or jugular vein<\/p>\n

Life threatening infection of the space between buccopharyngeal and prevertebral fascia; this potential space extends from base of skull to T1 in mediastinum.\u00a0 Peak incidence is in children < 6 y\/o.\u00a0 Caused by staph aureus, group A beta-hemolytic strep, or gram negative rods.\u00a0 Present with URI symptoms and pharyngitis. X-Ray shows space at C2 twice diameter of vertebral body.\u00a0 May also see air fluid levels or gas.\u00a0 Give antibiotics and get consult with head and neck surgeon, provide airway management, and admit to the PICU.<\/p>\n

<\/span>Peritonsillar Abscess<\/span><\/h2>\n

quinsy<\/em><\/strong>, abscess pushes uvula to other side of mouth.\u00a0 red, bulging soft palette.<\/p>\n

 <\/p>\n

Usually seen in children >8 y\/o.\u00a0 Complications of bacterial tonsillitis or superinfection of Epstein-Barr.<\/p>\n

Patients will have a hot potato voice, dysphagia, ipsilateral ear pain, trismus, dysarthria, and drooling.\u00a0 Pharynx exam will reveal an erythematous swollen tonsil which may displace the uvula to the opposite side.\u00a0 Manage with throat cx, and an ENT consult for needle drainage.\u00a0 If successfully drained, the patient can be give out-patient antibiotics.<\/p>\n

<\/span>Foreign Bodies<\/span><\/h2>\n

Balloons cause the highest number of deaths.<\/p>\n

Airway Chapter<\/a><\/p>\n

Many authors note a predilection for foreign bodies to lodge in the right main stem bronchus.\u00a0 However, several pediatric studies have noted a similar frequency in the distribution of foreign bodies between the right and left bronchial tree.\u00a0 Of note, hyperinflation maybe a subtle finding in the child suspected of having aspirated a foreign body.\u00a0 Bilateral decubitus chest radiographs can be obtained to facilitate demonstration of hyperinflation.\u00a0 Normally on a decubitus view, the dependent lung will have a loss of volume, as compared to the overlying lung.\u00a0 When an obstructing foreign body is present on the dependent side, air trapping is demonstrated by the absence of volume loss in the dependent lung.<\/p>\n

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