throat-itis
TRANSCRIPT
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Throat-itisTricia Falgiani, MDAssistant Professor
University of FloridaPediatric Emergency Medicine
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The Pediatric Airway
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LaryngotracheobronchitisCroup!Viral infection of larynx, trachea and bronchi
Parainfluenza (75%)InfluenzaRSVAdenovirus
6months-3 yearsMale > femaleWinter months
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Clinical PresentationFeverRhinorrheaNasal congestionBarking coughStridorRespiratory distressWorse at night
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Scoring System
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TreatmentLabs and xray unneccessaryMist therapyRacemic epinephrineDexamethasone
0.6mg/kg
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https://www.youtube.com/watch?v=Z1_uKqmPyLA&feature=player_detailpage
https://www.youtube.com/watch?v=Qbn1Zw5CTbA&feature=player_detailpage
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Epiglottitis
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EpiglottitisLife threatening bacterial infection of
epiglottis and surrounding structuresRare3-7 year oldsWinter monthsPathophysiology
H. InfluenzaeS. PneumoniaeGroup A streptococcusStaph aureus
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Clinical PresentationAbrupt onsetToxic appearingFeverStridorDroolingInability to swallowSore throatRespiratory distressTripod positionSudden obstruction
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TreatmentSecure airwayDon’t agitate childAntibiotics
CeftriaxoneCefotaximeMeropenemClindamycin/vanc ?
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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)
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Clinical PresentationSimilar to croupURI prodromeFeverStridorBarky coughHoarsenessSore throatNo droolingRespiratory distress
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TreatmentSecure airwayAntibiotics
CeftriaxoneMeropenemClinda or vanc
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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
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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
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Questions?