Throat-itisTricia Falgiani, MDAssistant Professor

University of FloridaPediatric Emergency Medicine

The Pediatric Airway

LaryngotracheobronchitisCroup!Viral infection of larynx, trachea and bronchi

Parainfluenza (75%)InfluenzaRSVAdenovirus

6months-3 yearsMale > femaleWinter months

Clinical PresentationFeverRhinorrheaNasal congestionBarking coughStridorRespiratory distressWorse at night

Scoring System

TreatmentLabs and xray unneccessaryMist therapyRacemic epinephrineDexamethasone

0.6mg/kg

https://www.youtube.com/watch?v=Z1_uKqmPyLA&feature=player_detailpage

https://www.youtube.com/watch?v=Qbn1Zw5CTbA&feature=player_detailpage

Epiglottitis

EpiglottitisLife threatening bacterial infection of

epiglottis and surrounding structuresRare3-7 year oldsWinter monthsPathophysiology

H. InfluenzaeS. PneumoniaeGroup A streptococcusStaph aureus

Clinical PresentationAbrupt onsetToxic appearingFeverStridorDroolingInability to swallowSore throatRespiratory distressTripod positionSudden obstruction

TreatmentSecure airwayDon’t agitate childAntibiotics

CeftriaxoneCefotaximeMeropenemClindamycin/vanc ?

Bacterial TracheitisRare (0.1 cases per 100,000 children per

year)Male > Female3 weeks- 16 yearsPathophysiology

Staph aureus (MRSA)Strep pyogenesStrep pneumoniaeMoraxella catarrhalisH. influenza type B (unvaccinated)

Clinical PresentationSimilar to croupURI prodromeFeverStridorBarky coughHoarsenessSore throatNo droolingRespiratory distress

TreatmentSecure airwayAntibiotics

CeftriaxoneMeropenemClinda or vanc

Epiglottitis vs. Croup vs. Bacterial tracheitisEpiglottitis 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

Causes of Stridor

Spasmodic croupRetropharyngeal abscessPeritonsillar abscessSubglottic stenoisAllergic reactionForeign bodyTracheomalaciaLaryngeal webLaryngeal papillomatosisLaryngeal hemangiomaTrachea fracture

Vocal cord paralysisInhalation injuryUvulitisVascular ringDouble aortic archAberran subclavian arteryPulmonary artery slingEpiglottitisBacterial tracheitisDiptheriacroup

Questions?