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Stridor
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Stridor
, Inspiratory Stridor, Biphasic Stridor
See Also
Wheezing
Stertor
Pathophysiology
Turbulent air flow in a partially obstructed upper airway results in a high pitched sound
Location of obstruction determines inspiratory or biphasic timing
Obstruction above the glottis results in Inspiratory Stridor
Obstruction at or immediately below the glottis results in both inspiratory and expiratory Stridor (Biphasic Stridor)
A child's small airways are impacted most significantly by even relatively small partial obstructions (Poiseuille's Law)
Infant: Airway edema of 1 mm reduces a 2 mm radius airway to 1 mm
Resistance to flow increases by 16 fold (Resistance = 1/r^4)
Adult: Airway edema of 1 mm reduces a 5 mm radius airway to 4 mm
Resistance to flow increases by 2-4 fold
Airway Radius By Age at Cricoid Cartilage
Age 0 to 1 year: 3 mm
Age 1 to 2 years: 3.75 mm
Age 2 to 4 years: 4 mm
Age 4 to 5 years: 4.5 mm
Epidemiology
Most common in younger children
Airway diameter reduction of 25% results in a cross-sectional airway reduction of 50% (see above)
Precautions
See
Awake Nasotracheal Intubation
Maintain airway and consider differential diagnosis
Ready all airway management equipment (RSI, intubation, failed airway)
Causes
By Age
Age <1 year (infants)
Laryngomalacia
(60%)
Croup
Vocal Cord Paralysis
Subglottic Stenosis
Airway
Hemangioma
Vascular Ring
s or slings
Age 1-3 years (toddlers)
Croup
Retropharyngeal Abscess
Epiglottitis
Foreign Body Aspiration
Age 4-18 years
Peritonsillar Abscess
Vocal Cord Dysfunction
Anaphylaxis
Hereditary Angioedema
Causes
Congenital
Choanal Atresia
Maxillofacial dysplasia
Vascular anomalies (e.g.
Vascular Ring
)
Laryngeal or tracheal abnormalities
Laryngomalacia
Tracheomalacia
Bronchomalacia
Subglottic Stenosis
Causes
Inflammatory or Infectious
Laryngotracheal Bronchitis
(
Croup
)
Epiglottitis
Bacterial Tracheitis
Tonsillitis
Diphtheria
Oropharyngeal deep space infection
Peritonsillar Abscess
Retropharyngeal Abscess
Causes
Neoplasm
Airway Papilloma
Airway
Hemangioma
Causes
Neurogenic
Vocal Cord Paralysis
Vocal Cord Dysfunction
Aspiration
Causes
Trauma
Foreign Body Aspiration
Facial Fracture
Mandibular
Fracture
Laryngeal Fracture
Subglottic Stenosis
Causes
Allergy
Spasmodic Croup
Angioneurotic edema
Precautions
Do not distress a child with suspected partial airway obstruction (e.g. croup)
Avoid unnecessary procedures (e.g. delay
Intravenous Access
until stable)
Position child as they are most comfortable
Management
Evaluate and treat specific conditions
Emergent management
See
Rapid Cardiopulmonary Asessment in Children
See
ABC Management
See
Respiratory Distress in the Newborn
See
Newborn Resuscitation
References
Dahan, Campbell and Melville (2020) Crit Dec Emerg Med 34(11): 3-10
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