Laryngeal & tracheal infections

Mind Map by , created almost 6 years ago

Paediatrics (Respiratory) Mind Map on Laryngeal & tracheal infections, created by v.djabatey on 12/12/2013.

Created by v.djabatey almost 6 years ago
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Laryngeal & tracheal infections
1 mucosal inflammation & swelling
1.1 rapid life-threatening airway obstruction in kids
1.1.1 characteristics stridor rasping sound heard mostly on inspiration hoarseness inflammation of vocal cords barking cough (like sea lion) dyspnoea variable degrees of
1.1.2 assessment of severity degree of chest retraction none only on crying at rest recession subcostal intercostal sternal more useful indicator of severity than RR degree of stridor none only on crying at rest or biphasic
1.1.3 if severe, complications... increasing resp rate increasing heart rate agitation central cyanosis or drowsiness means severe hypoxaemia need urgent intervention measure O2 sats pulse oximetry
1.1.4 Mx of acute upper airways obstruction don't examine throat! total obstruction of airway can be ppted by examn of throat using a spatula don't look at throat unless full resus eqpt & personnel are at hand reduce anxiety be calm, confident, well organised observe carefully for signs of hypoxia signs of deterioration if severe adminster nebulised adrenaline get anaesthetist! if resp failure develops


  • from increasing airway obstruction, exhaustion or secretions blocking the airway urgent tracheal intubation
2 Croup
2.1 aka viral laryngotracheobronchitis
2.2 airway
2.2.1 mucosal inflammn
2.2.2 increased secretions
2.3 oedema of subglottic region
2.3.1 may -> critical narrowing of trachea
2.4 pathogens
2.4.1 virus account for > 95% of laryngotracheal infections parainfluenza commonest cause human metapneumovirus RSV influenza
2.5 epidemiology
2.5.1 6mths- 6 years old
2.5.2 peak incidence @ 2 yrs old
2.5.3 commonest in autumn
2.6 Clinical features
2.6.1 severe barking cough
2.6.2 harsh, rasping stridor
2.6.3 hoarseness (voice, cry)
2.6.4 sx start & are worse @ night onset of sx over days
2.6.5 fever (<38.5 C) & coryza precede other sx
2.6.6 unwell appearance
2.7 Mx
2.7.1 inhalation of warm moist air often used but benefit unproven
2.7.2 steroids oral dexamethasone oral prednisolone nebulised steroids budesonide reduce severity & duration of croup reduce need for hospitalisation
2.7.3 mild upper airway obstruction stridor & chest recession disappear when @ rest manage child @ home parents observe child for signs for increasing severity
2.7.4 manage @ home or hosp? factors to consider severity of illness time of day ease of access to hosp parental understanding & confidence about illness child's age low threshold for admin for those <12 mths narrow airway calibre
2.7.5 severe upper airway obstruction nebulised adrenaline w/ O2 by facemask -> transient improvement close monitoring + anaesthetist/intensivist advice reduce risk of rebound sx rebound sx occur once effects of adrenaline diminish (after about 2 hrs) tracheal intubation few children
2.8 recurrent croup
2.8.1 may be related to atopy
3 Bacterial tracheitis (pseudomembranous croup)
3.1 Rare
3.2 danagerous
3.3 similar to viral croup
3.3.1 but high progressive fever toxic appearance rapidly progressive airway obstruction w/ copious thick airway secretions
3.4 Causative pathogen
3.4.1 Staph aureus
3.5 Rx
3.5.1 IV Abx
3.5.2 intubation (if need)
3.5.3 ventilation (if need)
4 Acute epiglottis
4.1 life-threatening
4.1.1 due to high risk of resp obstruction
4.2 causative pathogen
4.2.1 Haem influenzae type b Hib vaccine -> >99% decrease in incidence
4.3 intense swelling of epiglottis & surrounds
4.3.1 assoc w/ septicaemia
4.4 epidemiology
4.4.1 commonest in 1-6 yr olds but all age groups affected
4.5 Clinical features


  • note: must distinguish acute epiglottitis from croup AE  - NO PRECEDING CORYZA -absent or slight cough -fever &gt; 38.5 C -not able to drink -child appears v ill, toxic -soft, whispering stridor -muffled voice/cry, reluctant to speak 
4.5.1 acute onset (over hours)
4.5.2 v ill, toxic-looking child
4.5.3 intensely painful sore throat can't speak or swallow saliva drools down chin
4.5.4 soft inspiratory stridor
4.5.5 rapidly increasing resp difficulty over hours
4.5.6 child sits immobile, upright, w/ open mouth optimise airway
4.5.7 fever (>38.5 C)
4.5.8 absent or slight cough
4.6 Mx
4.6.1 urgent hosp admin & treatment
4.6.2 get senior anaesthetist paediatrician ENT surgeon
4.6.3 direct transfer to ICU or anaesthetic room intubate under controlled conditions under general anaesthetic if impossible (rare) urgent tracheostomy after securing airway take blood culture then give iv Abx e.g. cefuroxime 3-5 days remove tracheal tube after 24 hrs most recover completely within 2-3 days
4.6.4 prophylaxis offered to close household contacts riifampicin
4.7 DO NOT
4.7.1 lie child down
4.7.2 perform lateral neck X ray ppt total airway obstruction & death

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