Your SlideShare is downloading. ×
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Croup+Diphtheria+ Ac.Epiglottitis
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.

Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Croup+Diphtheria+ Ac.Epiglottitis


Published on

one of the commonest ent disease

one of the commonest ent disease

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide


  • 1. (Croup) Laryngotracheobronchitis
    • Mean age 18/12 month.
    • Boys more affected.
    • Causative organism.
      • Para-influenza virus type I.
      • Para-influenza virus type II.
      • Para-influenza virus type III.
      • Influnza virus type A.
      • Respiratory syncyteal virus.
      • Rhinovirus.
    • Not uncommon for secondary Bacterial infection to supervene.
  • 2.
    • Clinical picture:
      • Always preceded by U.R.T. I.
      • Hoarseness of voice.
      • Croupy cough (Musical cough) (Bark of a seal).
      • Strider initially inspirotary then Biphasic (due to subglottic oedema).
      • Pyrexia.
      • Flairing of ala nasae.
      • Suprasternal and intercostal recession.
    • Management of croup
    • Radiology
      • Neck X-ray
      • Chest X-ray (Steeple sign)
      • May need alternative airway 1%.
      • Provided epigloltitis is unlikely then conservative management.
    Lateral A.P
  • 3.
    • Observation:
    • Stridor – lessening
    • Restlessness
    • Color
    • Respiratory rate
    • Cardiac rate
    • Reassurance
    • Not to separate the child from parents.
    • Sedation of essential, chloral hydrate 30 mg/ Kg.
    • Humidification:
    • warm most air (tent) prevent drying of secretions ideal situation is a (croup room).
    • Hydration orally or I.V
    • Oxygen:
      • Pulse oxymetery oxygen given based on oxygen saturation.
    • Steroids:
    • As a last resort to resuscitate a child dexametha 0.6 mg/ Kg as a single dose.
  • 4.
    • ABI:
      • When 2ndy bacterial infection supervene
      • For intubate patients.
    • Rasemic adrenaline:
      • - Diluted with saline.
      • Nebulized.
      • At hospital.
      • 0.25 ml of 2.25%.
      • ECG monitoring.
    • Combination of:
      • Falling pulse rate.
      • Relaxation of restless child.
      • Quietening of stridor.
      • Maintenance of good colour.
      • Suggests favourable progress.
  • 5. Diphtheria
    • Rare when immunization is the rule.
    • Laryngeal diphtheria nearly always follows pharyngeal infection.
    • Causative organism is corynebacterium diphtheriae 3 strains (gravis – intermedius mitis). Nearly always it is the gravis strain responsible from major epidermics.
    • Mortality due to:
      • Laryngeal obstruction.
      • Production of endotoxin:
        • i- Myocarditis.
        • ii- Peripheral neuritis.
    • Initial lesion in region of tonsills grey membrane is formed bleeds in attempt to remove.
    • Bull neck due to cellulitis and regional lymphodenapathy.
  • 6.
    • Clinical features:
      • Onset is insidious.
      • Barking cough.
      • Stridor.
      • Chest wall recession.
      • Malaise.
      • Pyrexia.
      • Sore throat.
      • Membrane over the faucial pillars.
      • Toxaemia.
      • Dysphagia prior to laryngeal involvement.
      • Myocarditis during the second week of the disease.
      • Palatal paralysis with nasal regurgitation of food and nasal escape to the voice.
  • 7. Management:
    • Penicillin.
    • Antitoxin 10.000/ 100.000 unit.
    • Conservative therapy.
      • Humidification.
      • Oxygen.
      • If failed-remove the membrane from the larynx with intubation.
    • Bed rest for 2-4 weeks (danger of myocarditis).
  • 8. Acute epiglottitis
    • Causative organism:
      • Heamophilus influnzae (type B) commonest.
      • B hermolytic streptococcus.
      • Pnemococcus.
      • Staphylococcus.
    • More common in winter months.
    • Most cases seen in children between 1-6 years (peak 3-4).
    • In contrast to croup which affects younger children (peak 18 month).
    • Occationally seen in adult.
  • 9. Clinical features:
      • Sore throat.
      • ½ hour later dysphegia.
      • Inspiratory stridor (within 2 hours) critically ill patient.
      • Sitting up and learning forward.
      • If he lie back soffocation may occur (the epiglottis may occlude the larynx) and using his arm to fix his chest wall in order to use the accessory muscles of respiration.
    • Dribbling of saliva will be prefuse due to dysphgia.
    • Voice is muffled.
    • Inspiratory stridor.
    • As time passes the child becomes quite and floppy due to extreme fatigue indicates respiratory and cardiac arrest are imminent.
    • Frieghtent child.
    • Pyrexia shock and paller.
    • Cervical lymphadenopathy.
    • Don’t examine the pharynx.
  • 10. Management:
    • If the child thought to have epiglottitis.
    • Comfort the terrified child.
    • Don’t restrain the child as not to cause him crying and precipitate obstruction.
    • Radiology not advised though lateral neck X-ray may show (thumb) sign if the child condition permit and it is available at emergency room and there is doubt about diagnosis.
    • The child is carried to resuscitation room by his mother.
    • Anaesthetic, otolaryngological and pediatric staff will prepare to secure an alternative airway.
    • Anaesthesia is introduced in upright position.
  • 11.
    • If the child collapse prior to anesthesia intubation or bronchoscope without delay and without induction of anesthesia.
      • If failed rigid bronchoscope followed by tracheostomy.
      • Muscle relaxants are not used.
      • Avoid intravenous anesthesia induction.
      • Patient is in lateral semi-pron position.
      • Use semi-sold introducer.
  • 12.
      • If entrance of laryngeal inlet is not obvious sudden compression of the child chest will produce bubble of air in mucous.
      • If intubation failed introduce bronchoscope and may followed by tracheostomy at this stage.
      • Take culture swab from epiglottis.
      • Blood culture sample.
      • I.V infusion line for:
        • Replacement.
        • ABI (Chloramphnicol or Cefotaxime, Cefuroxime ).
      • Keep patient at I.C.U.
      • Sedation before transfer to I.C.U.
      • Extubation within 48 hours