Download - Throat-itis
Throat-itisTricia Falgiani, MDAssistant Professor
University of FloridaPediatric Emergency Medicine
The Pediatric Airway
LaryngotracheobronchitisCroup!Viral infection of larynx, trachea and bronchi
Parainfluenza (75%)InfluenzaRSVAdenovirus
6months-3 yearsMale > femaleWinter months
Clinical PresentationFeverRhinorrheaNasal congestionBarking coughStridorRespiratory distressWorse at night
Scoring System
TreatmentLabs and xray unneccessaryMist therapyRacemic epinephrineDexamethasone
0.6mg/kg
https://www.youtube.com/watch?v=Z1_uKqmPyLA&feature=player_detailpage
https://www.youtube.com/watch?v=Qbn1Zw5CTbA&feature=player_detailpage
Epiglottitis
EpiglottitisLife threatening bacterial infection of
epiglottis and surrounding structuresRare3-7 year oldsWinter monthsPathophysiology
H. InfluenzaeS. PneumoniaeGroup A streptococcusStaph aureus
Clinical PresentationAbrupt onsetToxic appearingFeverStridorDroolingInability to swallowSore throatRespiratory distressTripod positionSudden obstruction
TreatmentSecure airwayDon’t agitate childAntibiotics
CeftriaxoneCefotaximeMeropenemClindamycin/vanc ?
Bacterial TracheitisRare (0.1 cases per 100,000 children per
year)Male > Female3 weeks- 16 yearsPathophysiology
Staph aureus (MRSA)Strep pyogenesStrep pneumoniaeMoraxella catarrhalisH. influenza type B (unvaccinated)
Clinical PresentationSimilar to croupURI prodromeFeverStridorBarky coughHoarsenessSore throatNo droolingRespiratory distress
TreatmentSecure airwayAntibiotics
CeftriaxoneMeropenemClinda or vanc
Epiglottitis vs. Croup vs. Bacterial tracheitisEpiglottitis Croup Bacterial
Tracheitis
Anatomy Supraglottic Subglottic Tracheal lumen
Etiology Bacterial Viral Bacterial
Age Range 3-7 years, adults
6months-3 years
3weeks-16 yrs
Onset 6-24 hours 2-3 days 1-3 days
Toxicity Marked Mild to moderate
Mild- marked
Drooling Frequent Absent Absent
Cough Unusual Frequent Frequent
Hoarseness Unusual Frequent Frequent
WBC Leukocytosis Normal Leukocytosis
Causes of Stridor
Spasmodic croupRetropharyngeal abscessPeritonsillar abscessSubglottic stenoisAllergic reactionForeign bodyTracheomalaciaLaryngeal webLaryngeal papillomatosisLaryngeal hemangiomaTrachea fracture
Vocal cord paralysisInhalation injuryUvulitisVascular ringDouble aortic archAberran subclavian arteryPulmonary artery slingEpiglottitisBacterial tracheitisDiptheriacroup
Questions?