Stridor Presentation
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Stridor Presentation Stridor Presentation Presentation Transcript

  • Defined: High-pitched noisy breathing caused by turbulence from obstruction anywhere between nasal or oral cavity to the bronchi (harsh, creaking sound) Common in infants because of the small diameter of their airways Subtle abnormalities can cause obstruction in newborns and infants
  • Inspiratory Stridor Typically caused by obstruction at or above the level of the vocal cords Expiratory Stridor Usually localized to the more distal tracheobronchial tree Biphasic Stridor Usually caused by obstructions at the true vocal cords
  • Extrathoracic Airway Obstruction Usually present with symptoms of obstruction Hoarseness, brassy (“Barky”) cough, or stridor Presence of agitation, air hunger, severe retractions, cyanosis, lethargy require immediate intervention Diagnostic evaluation should include chest and lateral neck radiographs
  •  Congenital Laryngeal Anomalies  Laryngomalacia-different types  Tracheomalacia  Vocal Cord Paralysis  Laryngeal Clefts  Vascular Rings and Slings  Infectious  “Croup” (Laryngotracheitis)  Epiglottitis  Tracheitis  Trauma  Croup Masquerade  Subglottic Hemangioma  Recurrent Respiratory Papillomatosis  Post Intubation Glottic and Subglottic Lesions  Congenital Glottic and Subglottic Stenosis  Extra-Esophageal (Gastroesophageal) Reflux Disease/Eosinophilic Esophagitis  Foreign Body  Tracheal  Esophageal Laryngeal Stridor: Etiology
  • Presentation Staccato inspiratory stridor Worse with exertion, feeding, crying Noisy breathing generally begins at about 2-4 weeks of age  Endoscopic appearance Omega epiglottis Foreshortenend aryepiglottic folds Cuneiform prolapse
  • Acute Laryngotracheobronchitis
  • Inflammation of airway is present, but edema of the subglottic space accounts for the predominant signs of airway obstruction Common, usually between ages 6 mos to 3 yrs Boys>girls (3:2) Seasonal – Fall and Winter
  • Causative Organisms 75% of cases are caused by Parainfluenza types 1, 2 & 3 RSV Influenza A, B Rubeola Adenovirus M. pneumoniae Bacterial (pseudomembranous croup) Severe and life-threatening
  • Classic presentation Begins with URI symptoms (rhinorrhea, fever) Hours to days later, sxs of upper airway obstruction develop Hallmark is hoarseness and a barking or “croupy” cough (Seal bark) and inspiratory stridor Mild-severe respiratory distress Labored breathing, marked retractions
  • Diagnosis Based primarily on history and exam AP x-ray of the neck will show tapering subglottic narrowing “Steeple sign” Not necessary to make diagnosis
  • Prognosis Most have uneventful course and improve in a few days Recurrence can occur in some instances Suggests airway hyperreactivity
  • Supraglottitis
  • TRUE MEDICAL EMERGENCY! Inflammation of the epiglottis and adjacent structures Incidence has decreased dramatically with HIB vaccine Most cases occur in children 1-5 yrs. Boys>Girls (only slightly)
  • Causative organism Almost always H. influenza Others include: S. pneumoniae H. parainfluenza S. aureus
  • Presentation Progression of illness more rapid than croup Cough usually absent, high fever Drooling, apprehension, dysphagia, respiratory distress, and toxicity Resist lying down Classic “tripoding” posture Sits upright with arms forward in front and neck extended to maximize airway caliber “Sniffing” position – head forward, jaw thrust forward, mouth open
  • Diagnosis Extreme care must be taken not to agitate the patient or irritate the airway Lateral x-ray of the neck Thumb sign (rounded appearance of epiglottis) Thickened aryepiglotic folds
  •  Weak, hoarse cry  Mild-moderate respiratory  distress
  • Thank you