The document discusses various medical conditions and procedures related to respiratory obstruction, including stridor, dyspnea, and congenital high upper airway obstruction. It also covers topics such as subglottic stenosis, ear infections, and symptoms of herpes simplex virus infections in children. Treatment recommendations and complications associated with these conditions are highlighted throughout.

2.  Respiratory obstruction
 Stridor
 Weak cry
 Dyspnea
 Tachypnea
 Aspiration
 Cyanosis
 Sudden death

4.  Saccular cysts
 Similar to
laryngoceles
 Filled with mucous
 May need
immediate
trach/intubation*
 Endoscopically vs.
open

5.  Congenital High Upper Airway Obstruction
(CHAOS)
 1994– ultrasound with large lungs, flat
diaphragms, dilated airways, fetal ascites
 EXIT procedure (ex utero intrapartum
treatment)
 Multidisciplinary team
 C-section, maintain placental blood flow, quick tracheotomy

6.  Subglottic stenosis
 Acquired or
congenital
 Failure of laryngeal
lumen to recanalize
 Membranous vs.
cartilaginous
 Other anomalies
 Less than 4.0 mm
(3.5 mm)

7.  Subglottic stenosis
 Respiratory distress
at delivery to
recurrent croup
 Usually not at birth*
 History and PE
(biphasic stridor)
 Endoscopy
 Cotton grading
system

8.  Subglottic stenosis
 Most
conservative*
 Dilation or laser
not useful

9.  Auricle
 Tympanic
 membrane
 Middle ear
 and mastoid
 Inner Ear
Ear canal

10.  Usually put in by
patient, some bugs fly
in
 kill bugs with mineral
oil, or lidocaine
 remove with forceps,
suction or tissue
adhesive
 Complication:
Infection & mucosal
erosion

11.  Hematoma
- cartilaginous necrosis
- drain, antibiotics, bulky
ear dressing close
follow up
 Lacerations -
single layer closure,
pick up
perichondrium, bulky
ear dressing
Use posterior auricular
block for anesthesia

14.  Extremely painful
 Will cause canal
stenosis if not
immediately
treated
 Iccthammol pack
or bipp pack (short
duration)

15.  Discharge, pain, hearing loss,
itching
 Commonest organisms:
 S Aureus
 Ps Aeruginosa
 Proteus
 Predisposing factors:
 Water
 Cotton buds
 Eczema
 Treatment:
 Topical antibiotics
 Aural toilet
 Analgesia

16. Fungal Malignant OE
- Diabetes
- VII palsy

17. Rx : Systemic antibiotics
Analgesia
Decongestants
Symptoms:
Pain Discharge
Hearing loss Pain subsides

18.  Serous Otitis Media -
Eustachian tube dysfunction
- treat with decongestants,
decompressive maneuvers
 Otitis Media - infection of
middle ear effusion - viral
and bacteria
 Mastoiditis - Venous
connection with brain, need
aggressive treatment (can
lead to brain abcess or
meningitis)

23. Do not use forceps for round
objects

24.  Unilateral foul
smelling discharge
in children
 Usually lodge on
the floor of nose or
under middle
turbinate
 May aspirate

25. SeptumIT

27.  90% (Little’s Area) Kisselbach’s plexus - usually
children, young adults
Etiologies
 Trauma, epistaxis digitorum
 Winter Syndrome, Allergies
 Irritants - cocaine, sprays
 Pregnancy

30.  Most common
kesselbach’s plexus
 Squeeze nose tip 5-20
mins
 Insert cotton pledget
(with decongestant
 Cautery with sliver
nitrate
 Initial first aid
 Assessement of blood
loss
 Evaluation of cause
 Procede to stop
bleeding

32.  severe bleeding
 hypoxia, hypercarbia
 sinusitis, otitis media
 necrosis of the columella or nasal ala

35.  Signs and symptoms
- H/A, facial pain in sinus
distribution
- purulent yellow-green
rhinorrhea
- fever
- CT more sensitive than
plain films
 Causative Organisms
- gram positives and H. flu
(acute)
- anaerobes, gram neg
(chronic)

36.  Treatment
acute - amoxil, septra
chronic - amoxil-clavulinic acid,
clindamycin, quinolones
decongestants, analgesia, heat
 Complications
ethmoid sinusitis - orbital
cellulits and abcess
frontal sinusitis - may erode
bone (Potts Puffy Tumor,
Brain Abcess)

38.  Most common
strept and staph,
 Rarely H.Flu
 Can progress
rapidly
 Admit broad
spectrum
antibiotics

42. Very Opaque:
Cod, Haddock, Cole fish, Lemon sole,
Gurnard
Moderate Opaque:
Grey Mullet, Plaice, Monkfish, Red
Snapper
Not Opaque:
Herring (Kipper), Salmon, Mackerel,
Trout, Pike

44.  Irritants
-reflux, trauma, gases
 Viruses
- EBV, adenovirus
 Bacterial
-GABHS, mycoplasma, gonorrhea,
diptheria

45.  Complication of suppurative
tonsillitis
 Inferior - medial displacement
of tonsil and uvula
 dysphagia, ear pain, muffled
voice, fever, trismus
 Treatment
- Antibiotics, I&D, +/-steroids

46.  common presentation of primary herpes simplex
virus (HSV) infection in young children is herpetic
gingivostomatitis.
 children ages 6 months to 5 years.
 significant discomfort and disturbing appearance
 The primary infection may present with associated
flu-like symptoms, including an abrupt onset of
high fever, irritability, and malaise.
 Oral findings include erythematous, edematous,
and friable gingivae as well as oral and perioral
clusters of vesicles, which coalesce to form large,
painful ulcers. Symptoms usually last less than 1
week but may continue for up to 21 days

47.  Children 3 – 7 yrs and adults
 decrease incidence in children
secondary to HIB vaccine
 Onset rapid, patients look
toxic
 prefer to sit, muffled voice,
dysphagia, drooling,
restlessness

48.  Avoid agitation
 Direct visualization if patient allows
 soft tissue of neck
- thumb print, valecula sign
 Prepare for emergent airway, best achieved in a
controlled setting
 Unasyn, +/- steroids

49. Epiglottitis

50.  Anterior to prevertebral
space and posterior to
pharynx
 Usually in children under 4
(lymphoid tissue in space)
 pain, dysphagia, dyspnea,
fever
 swelling of retropharyngeal
space on lateral x-ray
 Complications -
mediastinitis

51.  Aphonia - complete upper airway
 Stridor - incomplete upper airway
 Wheezing - incomplete lower airway
 Loss of breath sounds- complete lower airway