Throat-itis

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Throat-itis

  1. 1. Tricia Falgiani, MD Assistant Professor University of Florida Pediatric Emergency Medicine
  2. 2. The Pediatric Airway
  3. 3. Laryngotracheobronchitis  Croup!  Viral infection of larynx, trachea and bronchi  Parainfluenza (75%)  Influenza  RSV  Adenovirus  6months-3 years  Male > female  Winter months
  4. 4. Clinical Presentation  Fever  Rhinorrhea  Nasal congestion  Barking cough  Stridor  Respiratory distress  Worse at night
  5. 5. Scoring System
  6. 6. Treatment  Labs and xray unneccessary  Mist therapy  Racemic epinephrine  Dexamethasone  0.6mg/kg
  7. 7.  https://www.youtube.com/watch?v=Z1_uKqmPyLA&f eature=player_detailpage  https://www.youtube.com/watch?v=Qbn1Zw5CTbA&f eature=player_detailpage
  8. 8. Epiglottitis
  9. 9. Epiglottitis  Life threatening bacterial infection of epiglottis and surrounding structures  Rare  3-7 year olds  Winter months  Pathophysiology  H. Influenzae  S. Pneumoniae  Group A streptococcus  Staph aureus
  10. 10. Clinical Presentation  Abrupt onset  Toxic appearing  Fever  Stridor  Drooling  Inability to swallow  Sore throat  Respiratory distress  Tripod position  Sudden obstruction
  11. 11. Treatment  Secure airway  Don’t agitate child  Antibiotics  Ceftriaxone  Cefotaxime  Meropenem  Clindamycin/vanc ?
  12. 12. Bacterial Tracheitis  Rare (0.1 cases per 100,000 children per year)  Male > Female  3 weeks- 16 years  Pathophysiology  Staph aureus (MRSA)  Strep pyogenes  Strep pneumoniae  Moraxella catarrhalis  H. influenza type B (unvaccinated)
  13. 13. Clinical Presentation  Similar to croup  URI prodrome  Fever  Stridor  Barky cough  Hoarseness  Sore throat  No drooling  Respiratory distress
  14. 14. Treatment  Secure airway  Antibiotics  Ceftriaxone  Meropenem  Clinda or vanc
  15. 15. Epiglottitis vs. Croup vs. Bacterial tracheitis Epiglottitis Croup Bacterial Tracheitis Anatomy Supraglottic Subglottic Tracheal lumen Etiology Bacterial Viral Bacterial Age Range 3-7 years, adults 6months-3 years 3weeks-16 yrs Onset 6-24 hours 2-3 days 1-3 days Toxicity Marked Mild to moderate Mild- marked Drooling Frequent Absent Absent Cough Unusual Frequent Frequent Hoarseness Unusual Frequent Frequent WBC Leukocytosis Normal Leukocytosis
  16. 16. Causes of Stridor  Spasmodic croup  Retropharyngeal abscess  Peritonsillar abscess  Subglottic stenois  Allergic reaction  Foreign body  Tracheomalacia  Laryngeal web  Laryngeal papillomatosis  Laryngeal hemangioma  Trachea fracture  Vocal cord paralysis  Inhalation injury  Uvulitis  Vascular ring  Double aortic arch  Aberran subclavian artery  Pulmonary artery sling  Epiglottitis  Bacterial tracheitis  Diptheria  croup
  17. 17. Questions?

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