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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
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Croup+Diphtheria+ Ac.Epiglottitis

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one of the commonest ent disease

one of the commonest ent disease

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  • 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

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