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1、StridorandUpperAirwayObstructionKevinRSchwartzMassachusettsGeneralHospitalDepartmentofPediatricsStridor:DefinitionExtrathoracicobstruction:-Supraglottic:epiglottitis,retropharyngealabscess,diptheria,anaphylaxis-Glottic/Subglottic:croup,laryngomalacia,vocalcordparalysisIntrathoracicob
2、struction:-foreignbodyaspiration,compressionbylymphnodesortumor,vascularwings/websStridor:DifferentialDiagnosisStatethemainideasyou’llbetalkingaboutViralCroupPathophysiology:viralinfectionwithmeasles,parainfluenzatypeIand3,influenzaA/B,RSVormetapneumoviruscauseslaryngotracheobronchit
3、is.Edemainthesubglotticregion,whichisboundbythecricoidcartilagecausesupperairwaynarrowing.Epidemiology:Mainlyaffectschildrenaged6mosto3yrswithpeakincidenceinsecondyearoflife.Boys>girls.ViralCroupClinicalPresentation:OftenantecedentURIsymptomsx12-48hoursfollowedbyonsetof“barky”charact
4、eristiccough,hoarsevoice,stridorandrespiratorydistress,maybeaccompaniedbyfeverashighas40CbutpatientshouldNOTdroolorappeartoxicPhysicalExaminationFindings:Observept’spositioning(?sniffingposition),mentalstatus,retractions/flaring,cyanosis,stridoratrestvs.w/agitation,hydrationstatus,Vi
5、ralCroupLabs/Studies:Labsuneccessaryfordiagnsosisandobtainingbloodworkmaybedistressingtopatient,worseningcondition.APandlateralneckradiographs:ViralCroup:TreatmentViralCroup:TreatmentViralCroup:TreatmentBjornson,CLetal.Croup.TheLancet2008;371:329-339d/chomeadmitDiptheria:Pathophysiol
6、ogyandEpidemiologyPathophysiology:Corynebacteriumdiptheriae(gram-positivepleomorphicbacillus)infectsupperrespiratorytractand,after2-4daysincubation,elaboratesatoxinwhichcausesnecrosisofmucousmembranesandformationofpseudomembranes.Thetoxinmayalsoaffectheart,nervesandkidneys.Epidemiolo
7、gy:endemicinAfrica,Asia,SouthAmerica.V.rareinimmunizedpopulations,mostlyaffectingchildren<15y/oDiptheria:ClinicalPresentationNasalDiptheria(mostoftenininfants):mildrhinorrheawhichprogressestomalodorous,mucopurulentdrainageTonsillar/PharyngealDiptheria:beginsw/malaise,low-gradefeveran
8、dpharyngitis
