This lecture will discuss Approach to Acute infective upper airway obstruction (infective stridor) in children and paediatric age group.
Topics:-
Stridor
Stridor
croup,
Epiglottitis
laryngitis,
bacterial tracheitis
Retropharyngeal abscess
Spasmodic Croup
prdiatrics notes, croup, upper respiratoty track infection
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/11/pediatrics-notes-croup.html
prdiatrics notes, croup, upper respiratoty track infection
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/11/pediatrics-notes-croup.html
to differentiate b/w wheezing and stridor....lead to know to make clinical dx for asthma, croup, laryngomalacia, epiglottis...there many noisy breathing....our focus wheezing n stridor....
Acute laryngotracheobronchitis, commonly known as croup, is a respiratory condition that primarily affects infants and young children. It is characterized by inflammation of the larynx (voice box), trachea (windpipe), and bronchi (large airways in the lungs). Croup is often caused by viral infections, with parainfluenza virus being a common culprit
to differentiate b/w wheezing and stridor....lead to know to make clinical dx for asthma, croup, laryngomalacia, epiglottis...there many noisy breathing....our focus wheezing n stridor....
Acute laryngotracheobronchitis, commonly known as croup, is a respiratory condition that primarily affects infants and young children. It is characterized by inflammation of the larynx (voice box), trachea (windpipe), and bronchi (large airways in the lungs). Croup is often caused by viral infections, with parainfluenza virus being a common culprit
Approach to patient with spinal cord lesions & diseases
Localize spinal cord lesions
Determining the Level of the Lesion in Myelopathy
Diseases of spinal cord
This is a comprehensive approach to a hypertensive patient presenting to the emergency department.
Discussing:-
- Hypertensive emergency
- Hypertensive Urgency
- Hypertensive Crisis
- Hypertensive encephalopathy and retinopathy
- Accelerated Hypertension
- Malignant hypertension
this is a complete discussion and an approach to a child with febrile seizure / convulsion.
It contains:-
Case scenario
Causes of Seizures in the setting of fever
Definition of Febrile Seizure
Age of Occurrence
Types of Febrile Convulsions
Risks of Recurrent Febrile Seizures
Risk For Developing Epilepsy After Febrile Seizures
Workup for Febrile Seizure
Red Flags in Febrile Seizures
Treatment
Prognosis
Approach to Syncope in Children (Pediatric Syncope).pptxJwan AlSofi
Approach to Syncope in Children (Pediatric Syncope), includes:-
Introduction
Differential diagnosis of syncope
Syncope vs vertigo vs Presyncope vs light-headedness.
Comparison of Clinical Features of Syncope and Seizures
Neurocardiogenic (Vasovagal) syncope
MECHANISMS and Causes of Syncope
Cardiac causes of syncope
Life-threatening causes of syncope
Red Flags in Evaluation of Patients With Syncope
Non-cardiac causes of loss of consciousness.
Noncardiac Causes of Syncope
Differentiating Features for Causes of Syncope
EVALUATION of syncope:- History, Examination,Treatment.
Summary
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
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Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
7. Indications for imaging and direct laryngoscopy:-
1. Stridor in infants younger than 4 months of age,
2. positional stridor,
3. persistence of symptoms for longer than 1 week
8. Croup (Viral Laryngiotrachiobronchitis)
• Heterogeneous group of acute and infectious processes
characterized by
1. barking or brassy cough
2. hoarseness,
3. inspiratory stridor
4. respiratory distress.
• Is the most common infection of the middle respiratory
tract.
9. Pathology:-
•Laryngotracheal airway inflammation
disproportionately affects children
because a small decrease in diameter
secondary to mucosal edema and
inflammation exponentially increases
airway resistance and the work of
breathing.
•During inspiration, the walls of the
subglottic space are drawn together,
aggravating the obstruction and
producing the stridor characteristic
of croup.
13. Etiology:-
• Parainfluenza viruses (types 1, 2, 3) are responsible for about 80% of croup
cases.
• Other infectious causes of croup-like illnesses include the following:
─Adenovirus
─Respiratory syncytial virus (RSV)
─Enterovirus
─Human bocavirus
─Coronavirus
─Rhinovirus
─Echovirus
─Reovirus
─Metapneumovirus
─Influenza A and B
14. Prevalence:-
• Gender
The male-to-female ratio for croup is approximately 1.4:1.
• Age
- Primarily a disease of infants and toddlers.
- Croup has a peak incidence in patients from age 6 months to 3 years.
- In adolescents, it manifests as laryngitis.
15. Natural history of croup:-
1. Most patients have an URTI with some combination of rhinorrhea, pharyngitis, mild cough,
and low-grade fever for 1-3 days before the signs and symptoms of upper airway
obstruction become apparent.
2. The child then develops the characteristic barking cough, hoarseness, and inspiratory
stridor.
• Symptoms are characteristically worse at night .
• Most ED visits occurring between 10 pm and 4 am.
• Other family members might have mild respiratory illnesses with laryngitis.
• Symptoms typically resolve completely within 3-7 days but can last as long as 2 weeks..
16. Clinical Features- History:-
• Coryza.
• Stridor
▫ is a harsh, high-pitched respiratory sound produced by turbulent airflow.
▫ It is usually inspiratory, but it may be biphasic
▫ is a sign of upper airway obstruction.
• Harsh cough described as barking or brassy,
• Fever:-
▫ The low-grade fever can persist.
▫ Some children are afebrile.
• Hoarseness
• Symptoms are characteristically worse at night .
• Agitation and crying greatly aggravate the symptoms and signs.
• The child may prefer to sit up in bed or be held upright.
17. Clinical Features- Physical examination:-
1. Normal to moderately inflamed pharynx.
2. Slightly increased respiratory rate.
3. Wheezing may be present if there is associated lower airway involvement.
• Rarely, the upper airway obstruction progresses and is accompanied by:-
- labored breathing
-cyanosis
-an increasing respiratory rate;
-nasal flaring;
-suprasternal, infrasternal, and intercostal retractions;
-continuous stridor.
• Croup is a disease of the upper airway, and alveolar gas exchange is usually normal
Hypoxia and low oxygen saturation are seen only when complete airway
obstruction is imminent.
• The child who is hypoxic, cyanotic, pale, or obtunded needs immediate airway
management.
18.
19. LABORATORY Findings:-
Routine laboratory studies are not useful in establishing the diagnosis.
Leukocytosis is uncommon and suggests epiglottitis or bacterial tracheitis.
Many rapid tests (using [PCR]) are available for parainfluenza viruses, RSV, and other less
common viral causes of croup, such as influenza and adenoviruses.
20. Radiological Findings:-
Croup is a clinical diagnosis and does not require a radiograph of the neck.
Radiographs are considered only after airway stabilization in:-
1. Distinguishing between severe laryngotracheobronchitis and epiglottitis,
2. Children who have an atypical presentation or clinical course.
The radiographs do not correlate well with disease severity.
Lateral radiograph of the upper airway (Anteroposterior radiographs of the neck)
shows:
─ Normal epiglottis
─ Narrowing of the subglottic region
─ Steeple sign in a patient with croup
Steeple sign:-
-may be absent in patients with croup,
-may be present in patients without croup as a normal variant,
-May rarely be present in patients with epiglottitis.
23. DIFFERENTIAL DIAGNOSIS:-
•The infectious differential diagnosis includes
1. epiglottitis,
2. bacterial tracheitis
3. parapharyngeal abscess.
•Noninfectious causes of stridor include
▫ mechanical and anatomical causes (foreign body aspiration, laryngomalacia,
subglottic stenosis, hemangioma, vascular ring, vocal cord paralysis).
24. Treatment of Croup:-
1) General Measures
• Children with mild symptoms can be treated with
-humidity,
-antipyretics,
-oral hydration at home.
• Short, acute episodes of stridor can be treated with
-cool mist administered by face mask,
-a bathroom filled with steam from a shower
-cold night air.
• If the stridor persists, worsens or occurs at rest, the child should be seen in the emergency room.
▫ It is important to try to keep the child calm to minimize forceful inspiration as agitation or
anxiety can worsen symptoms and increase work of breathing.
25. 2) Medications
• Corticosteroids and nebulized racemic epinephrine are the first-line treatments for croup.
1. Oral or intramuscular dexamethasone
Reduces symptoms and the need for hospitalization, and shortens hospital stays.
Dexamethasone (0.6-1 mg/kg) may be given once intramuscularly or orally.
Alternatively, prednisolone (2 mg/kg/day) may be given orally in two to three divided doses.
2. Aerosolized racemic (D- and L-)epinephrine
Reduces subglottic edema by adrenergic vasoconstriction, temporarily producing marked clinical
improvement.
The peak effect is within 10-30 minutes and fades within 60-90 minutes.
A rebound effect may occur, with worsening of symptoms as the effect of the drug dissipates.
Aerosol treatment may need to be repeated every 20 minutes (for no more than 1-2 hours) in severe cases.
Dose: 0.5 mL of 2.25% solution (D- and L-isomers) in 2.5 mL normal saline delivered via nebulizer as needed.
L-epinephrine: If racemic epinephrine is not available, 5 mL of L-epinephrine 1:10,000 delivered via nebulizer is
effective.
27. COMPLICATIONS AND PROGNOSIS:-
1. The most common complication of croup is viral pneumonia, which occurs in 1-2%
of children.
Parainfluenza virus pneumonia and secondary bacterial pneumonia are more common in
immunocompromised patients.
2. Bacterial tracheitis may also be a complication of croup.
• The prognosis for croup is excellent.
27
28.
29. • Epiglottitis is a medical emergency because of the risk of sudden airway obstruction
• Is a potentially lethal condition characterized by acute rapidly progressive and potentially
fulminating course of high fever, sore throat, dyspnea, and rapidly progressive
respiratory obstruction and distress (variable).
• Often, the otherwise healthy child suddenly develops a sore throat and fever.
• Within hours, the patient:-
-Appears toxic
-Difficult swallowing,
-Drooling
-Labored breathing.
-Neck is hyperextended in an attempt to maintain the airway.
Acute Epiglottitis (Supraglottitis)
30. Etiology
1. Non-typeable H. influenzae,
2. H. influence type b – in unimmunized patients
3. Staphylococcus aureus
4. Group A streptococcus
• Epiglottitis used to occur among 2-4 yr old children (range from 1 to 7 yr).
31. Clinical Features:-
• Very limited or no prodrome of mild (URI).
• Abrupt onset of high fever (39–40◦C), sore throat, and dysphagia.
• “Hot potato” voice.
• Rapid onset of toxicity and respiratory distress.
• No Cough– and if it occurs it is usually late symptoms.
• Usually no other family members are ill with acute respiratory symptoms.
• Time from onset of symptoms to presentation with progressive respiratory distress is generally <12
hours.
• Child’s preferred way of sitting or positioning himself or herself (i.e. sitting upright, leaning forward
with chin hyperextended).
Immunization against H. influenzae type B.
Exposure to cats.
32. Physical Exam:-
• Extremely anxious, may appear distressed and toxic appearance.
• The child prefers to remain sitting up.
• The child often sitting “tripod” position / “sniffing position”:-
▫ sitting upright and leaning forward
▫ the chin up, mouth open and the jaw thrust forward
▫ bracing on the arms to maintain airway in a.
• Slow and labored respiratory effort.
• Drooling is seen as a manifestation of dysphagia.
• Inspiratory stridor, retractions, and late cyanosis
• Stridor is a late finding and suggests near-complete airway obstruction.
• Complete obstruction of the airway and death can ensue unless adequate treatment is provided.
• Diagnosis can be suspected on history and observation of child’s appearance alone.
• Do not attempt to examine the throat if epiglottitis is a serious consideration.
34. Diagnosis:-
• The diagnosis requires direct visualization
under controlled circumstances by
laryngoscopy showing:-
▫ inflamed and swollen supraglottic structures
▫ a large, cherry red, swollen epiglottis.
• Classic radiographs of a child who has
epiglottitis show the thumb sign.
• Anxiety-provoking interventions such as
phlebotomy, intravenous line placement,
placing the child supine, or direct inspection
of the oral cavity should be avoided until the
airway is secure.
• Cultures of blood, epiglottic surface, and, in
selected cases, cerebrospinal fluid should be
collected after the airway is stabilized.
35. Treatment of Epiglottitis:-
• Initial Stabilization.
• Airway management:
-Maintain child upright, never supine.
-<2 years old: allow the child to assume his or her most comfortable position (usually in the mother’s
arms/lap).
-Personnel experienced in airway management should accompany the child at all times, including
during transport and in radiology.
-Establishing an airway by endotracheal or nasotracheal intubation or, less often, by tracheostomy is
indicated in patients with epiglottitis, regardless of the degree of apparent respiratory
distress, because as many as 6% of children with epiglottitis without an artificial airway die,
compared with <1% of those with an artificial airway.
• Oxygen by mask or blown by face.
-All patients should receive oxygen en route unless the mask causes excessive agitation.
• Transport to operating room as soon as possible for anesthesia and intubation, followed by positive
pressure ventilation as necessary.
36. Medications
First Line
▫ Empiric antibiotic coverage to include gram-positive cocci and β-lactamase producing H. influenzae
type B: Cefuroxime: 150 mg/kg/d divided q8h
▫ Staphylococcal disease (14–21 days): switch may be made to oral medication after extubation and
resumption of feeding.
Second Line
▫ Cefotaxime, ceftriaxone, or meropenem should be given parenterally, pending culture and
susceptibility reports, because 10-40% of H. influenzae type B cases are resistant to ampicillin.
▫ Treatment is continued for at least 10 days.
*** Racemic epinephrine and corticosteroids are ineffective.
37. Differential Diagnosis
• Viral laryngotracheobronchitis (croup) with or without secondary bacterial tracheitis.
• Severe parainfluenza or influenza infection.
• Uvulitis
• Peritonsillar, retropharyngeal, or lingual abscess.
• Foreign body aspiration in a child with URI.
• URI, including croup, in a child with a congenital or acquired airway problem (e.g.
premature infant with subglottic stenosis, laryngeal web, vascular ring, tracheal stenosis).
• Hereditary angioedema (deficiency of complement C1 esterase inhibitor) can present with
edema of the airway including the epiglottis.
38. Is superinfection of the trachea that may follow viral croup
is a rare
serious
is most commonly caused by S. aureus.
Patients may be toxic appearing
intubation may be required.
Bacterial tracheitis
39. Clinical features of croup (viral laryngotracheitis)
and bacterial tracheitis/epiglottitis:-
39
41. •The retropharyngeal space can become infected in two ways :
1. Infection spreads from a contiguous area
2. Penetrating trauma (can directly inoculate the space)
•Once Infected, the nodes may progress through 3 stages:
1. cellulitis,
2. Phlegmon
3. Abscess.
•The "classic" retropharyngeal abscess observed in pediatric
patients occurs when an upper respiratory tract infection (URTI)
spreads to retropharyngeal lymph nodes, forming chains in the
retropharyngeal space on either side of the superior constrictor
muscle.
•Retropharyngeal nodes involute at 5 years of age….so the abscess
doesn’t occur after 5 years of age.
41
42. Clinical Presentation:-
• Sore throat
• Fever
• Neck pain
• Neck stiffness (torticollis)
• Jaw stiffness (trismus)
• Stridor
• Drooling of saliva
• Muffled voice
• Sensation of lump in the throat
• Breathing difficulties
• Sometimes an upper respiratory illness can precede symptoms by weeks.
42
43. Investigation:-
1. Laboratory Studies (Non-
specific)
- WBC counts can be elevated
- Culture and sensitivity test (Gram stain can
help direct with empiric antibiotic
treatment).
2. Imaging Studies (Lateral plain
X-ray)
- Perform the study during inspiration
with the neck held in normal extension
- May also demonstrate gas or a foreign
body in the retropharyngeal space.
43
44. •CT scan
1. It can be useful in identifying rertropharyngeal, parapharyngeal or lateral pharyngeal
abscess.
2. Deep neck infections can be easily identified.
3. With contrast, it can reveal central lucency or scalloping of the walls of lymph node, which
is thought to predict abscess formation
•
44
45. Management:-
• ABC - Determining airway stability remains a top priority.
• Allow patients to remain in a position of comfort, which is usually supine with their necks
extended. Neck flexion or forcing a child to sit up can occlude the airway.
• Remember that sedatives and paralytics can cause relaxation of airway muscles with
subsequent complete occlusion!
• Start empiric antibiotic therapy without delay (After obtaining blood culture results) Broad-
spectrum coverage is indicated.
• A 3rd generation cephalosporin combined with ampicillin-sulbactum or
clindamycin is effective.
• CT scanning or ultrasonography may be used to help guide the aspiration.
• Drainage is necessary in patients with respiratory distress or failure to improve with IV
antibiotics.
• Some authors advocate the use of antibiotics alone for small abscesses. These patients need to
be closely monitored for improvement.
45
46. • Laryngitis is a common illness.
• Viruses cause most cases; diphtheria is an exception but is extremely rare in
industrialized countries .
• The onset is usually characterized by an upper respiratory tract infection during which
sore throat, cough, and hoarseness appear.
• The illness is generally mild.
• Respiratory distress is unusual except in the young infant.
• Hoarseness and loss of voice may be out of proportion to systemic signs and symptoms.
• The physical examination is usually not remarkable except for evidence of pharyngeal
inflammation.
• Inflammatory edema of the vocal cords and subglottic tissue may be demonstrated
laryngoscopically.
• The principal site of obstruction is usually the subglottic area.
Acute Infectious Laryngitis
47. •Is sudden onset of croup symptoms, usually at night, but
without a significant upper respiratory tract prodrome.
•These episodes may be recurrent and severe but usually are
of short duration.
•Spasmodic croup has a milder course than viral croup and
responds to relatively simple therapies, such as exposure to
cool or humidified air.
•The etiology is not well understood and may be allergic.
Spasmodic Croup
50. Mother brought her 18-month-old infant to ER with history of URTI for the
last 2 days with mild respiratory distress. This evening the infant starts to
have a hard barking cough with respiratory distress. O/E: T 38C, RR 40/min,
associated with nasal flaring, suprasternal & intercostal recessions.
Auscultation to the chest shows equal air entry bilaterally, prolonged
expiratory phase, and crackles.
What is the most likely diagnosis?
a) Gastroesophageal reflux
b) Laryngotracheobronchitis
c) Viral Pneumonia
d) Bronchiolitis
e) Bacterial Pneumonia
Answer: b
51. Regarding the treatment of CROUP, choose the line of treatment needed:
a) Sedatives
b) IV fluid
c) Racemic epinephrine
d) Humidified oxygen
e) Corticosteroid
Answer: d