#paeds
see also: [[cough (paeds)]], [[Upper airway obstruction (paeds)]], [[Sore throat]]
> slightly different table in the pads [[Upper airway obstruction (paeds)|upper airway obstruction]] section
# Paeds Stridor
| disease | History | Exam | age | Ix | Mgmt |
| --------------------------------------------------- | ------------------------------------------------------------------------------ | ---------------------------------------------------------------- | -------------------------------- | ---------------------------------------------------- | --------------------------------------------------------------------- |
| [[Croup]] | - a/w URTI<br>- barking cough | +/- fever<br>high pitched stridor | 6m - 6y | nil | supportive<br>steroids<br>+/- adrenalien |
| Epiglottitis | - sudden onset<br>- rapid progression<br>- no preceding cough<br>- URTI 25-50% | - sitting up<br>- toxic, pale, drooling<br>- low pitched stridor | usually ~2 years | XR ("thumb sign")<br>blood m/c/s | Abx<br>supportive |
| [[inhaled foreign body]] | possible choking; usually food<br>balloons high risk | wheeze (80%)<br>decreased air entry<br>stridor 10% | usually < 3 years | XR not sufficient to exclude | bronchoscopy and removal |
| bacterial tracheitis | - URTI for a few days<br>- ↑ fever<br>- neck pain<br>- dry cough | unwell appearance | 1-5 y | XR may show scalloped appearance of internal trachea | anti-staph:<br>cef3 50mg/kg<br>cefotaxime 50mg/kg <br>pip-taz 50mg/kg |
| [[Parapharyngeal abscess\|retropharyngeal abscess]] | fever<br>neck pain<br>sore throat<br>dysphagia | drooling<br>hyperextension of neck<br>[[Torticollis]] | usually < 6 years<br>median ~ 3y | XR<br>CT | abx<br>airway mgmt<br>ENT/ surg |
| trauma | mechanical blow to neck<br>chemical or thermal ingestion | bruising<br>laceration<br>burns<br>dysphagia and drooling | | | |
| congenital | eg tracheomalacia, laryngomalacia, subglotting stenosis, vascular abnormality | low grade stridor - may be exacerbated by URTI | usually < 6 mo | | |
| [[Anaphylaxis]] / angioedema | | | | | |
| diphtheria | | | | | |
| [[Laryngospasm]] | | | | | |
| anterior mediastinal tumour | | | | | |
## by anatomical location
- inspiratory stridor
- usually *supraglottic*
- **critical Dx:**
- epiglottitis
- pharyngeal abscess
- tonsillar hypertrophy
- macroglossia (Trisomy 21)
- lingual thyroid
- thryoglossal duct cyst
- choanal atresia
- biphasic stridor
- usually *glottic*
- **critical Dx**
- croup
- foreign body
- hemangioma of vocal cord
- vocal cord palsy
- laryngeal web
- laryngomalacia
- Expiratory stridor
- usually sub-glotic
- **critical Dx:**
- bacterial traceitis
- croup
- foreing body
- subglottic stenosis
- tracheomalacia
- vascular rings
- mediastinal mass
## by time-course
| Acute | Subacute | Chronic |
| ------------------------------------------------------------------------------------------------------------------------------------------------------ | -------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| - [[inhaled foreign body\|foreign body]]<br>- [[Airway#Burns airway\|airway burns]]<br>- [[Caustic Ingestions]]<br>- [[Anaphylaxis]]<br>- epiglottitis | - [[Croup]]<br>- [[Parapharyngeal abscess\|retropharyngeal abscess]]<br>- [[peritonsilar abscess]] | - laryngomalacia<br>- tracheomalacia<br>- subglotic stenosis<br>- vocal cord dysfunction / paradoxical vocal cord motion<br>- vascular ring<br>- bronchogenic cyst<br>- laryngeal malformation<br>- infantile haemangioma<br>- [[Hypocalcemia]] laryngeal spasm |
# post-extubation stridor
- from an ED perspective if there is a wheeze not responding to bronchodilators in a recently intubated patient, can consider subglottic stenosis
- until I make more notes on this topic, see [Deranged physiology - post-extubation stridor](https://derangedphysiology.com/main/required-reading/airway-management/Chapter%203.1.2/post-extubation-stridor)