Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx...
-
Upload
charles-simmons -
Category
Documents
-
view
219 -
download
0
Transcript of Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx...
![Page 1: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/1.jpg)
Upper Airway Obstruction
Noisy Breathing
![Page 2: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/2.jpg)
Upper Airway
• Nose
• Nasopharynx
• Oropharynx
• Larynx (supraglottis, subglottis)
• Trachea (extrathoracic)
![Page 3: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/3.jpg)
![Page 4: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/4.jpg)
Upper Airway Obstruction
Noisy Breathing
Noise during INSPIRATION Noise during EXPIRATION
Difficulty breathing OUT
Distal to Thoracic InletTrachea, bronchi, peripheral
airways
Difficulty breathing IN
Proximal to Thoracic InletNose, pharynx, larynx
![Page 5: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/5.jpg)
Upper Airway Obstruction
Difficulty breathing IN
Awake/Crying IMPROVES
Awake/CryingDETERIORATES
LarynxNose / Pharynx
![Page 6: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/6.jpg)
Upper Airway ObstructionNoise decreases as obstruction worsens
0102030405060708090
100
Noise NOT
indicative of degree of
obstruction
therefore
THE WORST OBSTRUCTION IS SILENT
![Page 7: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/7.jpg)
Upper Airway Obstruction
Which clinical signs are indicative of the severity of obstruction? Recession (sternal, lower costal margin) Tachypnoea Tachycardia Expiratory difficulty (abdominal muscles contract) Depressed consciousness Cyanosis Noise soft/absent
![Page 8: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/8.jpg)
Where in the Airway is the Obstruction
Snoring Stridor Wheeze
Naso
pharynx
+ + -
Larynx ±Small babies
+ +Severe obstr
Trachea &
bronchi
+ +
Small airways
+
![Page 9: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/9.jpg)
Obstruction in Upper Airway versus Lower Airway
AIR TRAPPING - PERCUSSION
Upper border of liver displaced downwards
Cardiac dullness not detected
![Page 10: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/10.jpg)
Upper Airway ObstructionApproach
• History
• Age
• Clinical examination
Site of obstruction
Severity
![Page 11: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/11.jpg)
Upper Airway Age
• Short
• Narrow
• Elastic
• Tendency to collapse
![Page 12: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/12.jpg)
Upper Airway
Resistance to airflow through
a tube is inversely proportional to
the radius4
![Page 13: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/13.jpg)
Upper AirwayInfant/Child
Scenario: Airway 4 – 5 mm diameter 1 mm oedema• Resistance increases 16 times (adult 3 times)• Surface area decreases by 75% (adult 45%) Upper airway of a child not a miniature replica
![Page 14: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/14.jpg)
Upper AirwayNose
• “Blocked” nose (infants < 6 months)
• Choanal atresia
• Foreign body
• Polyps
• Allergy
![Page 15: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/15.jpg)
Upper AirwayNose
• “Blocked nose”
(0 – 6 months)• Choanal atresia• Foreign body• Polyps• Allergy
![Page 16: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/16.jpg)
Upper AirwayOropharynx
• Adenoidal hypertrophy
(Obstructive sleep apnoea)
• Micrognathia• Craniofacial abnormalities• Large tongue
![Page 17: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/17.jpg)
Upper AirwayOropharynx
OBSTRUCTIVE SLEEP APNOEA
Adenoidal hypertrophy
Snoring
Sudden death during sleep
Craniofascial abnormalities
Micrognathia
![Page 18: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/18.jpg)
Oropharynx
Obstructive sleep apnoea High index of suspicion (10%) Examine child while asleep Early diagnosis and treatment Prevent complications Hypoxaemia Growth failure Sudden death
![Page 19: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/19.jpg)
Upper AirwaySupraglottis
Epiglottitis (H.influenza type B) Acute onset Drooling Pyrexia Posture
AIRWAYANTIBIOTICS
![Page 20: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/20.jpg)
Upper AirwayLarynx
• Laryngomalacia
• Webs, cysts
• Vocal cords
(paralysis, papillo-
mata)
![Page 21: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/21.jpg)
Larynx
Laryngomalacia
Obstruction
Inspiratory, variable
Newborn infant, stridor (awake)
Improves: prone, sleep, age
Voice normal
![Page 22: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/22.jpg)
Larynx
Laryngeal papillomata
6 months – 5 years
Inspiratory stridor
Voice HOARSE
Not associated with infection
REFERRAL
![Page 23: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/23.jpg)
Upper AirwaySubglottis
Laryngotracheobronchitis (Croup) 6 months – 2 years Preceded by a cold (Parainfluenza) Stridor Normal voice Barking cough Grade severity of obstruction
![Page 24: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/24.jpg)
Croup Grading according to Severity of Obstruction
Severity Inspiratory Obstruction
Expiratory
Obstruction
Pulsus Paradoxus
Grade 1 + - -
Grade 2 + Passive -
Grade 3
(Grade 4
apathy, cyanosis)
+ Active +
![Page 25: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/25.jpg)
Croup
Treatment
Adrenaline inhalations
Steroids
Avoid crying
Airway – intubation
tracheostomy
![Page 26: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/26.jpg)
Upper AirwaySubglottis
Congenital subglottic stenosis
<6 months
No preceding infection
History of intubation
Endoscopy
Tracheostomy
![Page 27: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/27.jpg)
Upper AirwayBacterial Tracheitis
• Older child (<2 years)
• Toxic, erythematous rash
• Thick secretions
• Airway (tracheostomy)
• Staphylococcus aureus
![Page 28: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/28.jpg)
Upper AirwayForeign Body
• May lodge in any part of airway
• HISTORY
• X-rays
• Endoscopy
![Page 29: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/29.jpg)
Upper AirwayRetropharyngeal Abscess
• <6 months
• Sore throat (anorexia) for several days
• Pyrexia, drooling, stridor
• X-ray: prevertebral space increased
• Surgical drainage
• Antibiotics
![Page 30: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/30.jpg)
![Page 31: Upper Airway Obstruction Noisy Breathing. Upper Airway Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)](https://reader033.fdocuments.us/reader033/viewer/2022051517/56649cf55503460f949c38b6/html5/thumbnails/31.jpg)