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37 Cards in this Set

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Peritonsillar Abscess Etiology;
Usually Group A Hemolytic Streptococcus
also Anaerobic microorganisms (bacteroides)
Peritonsillar Abscess S/Sx;
Painful (severe) swallowing, febrile & toxic pt, head tilts toward the side of the abscess, marked trismus, tonsil displaced medially, soft palate erythematous & swollen, uvula is edematous & displaced, drooling from inability to swallow, "hot potato" voice.
Peritonsillar Abscess tx;
Aimed at tx of infection & relief of sx, IV ABX, Decadron (Steriod), surgical drainage, Analgesics, Tonsillectomy.
Indications for tonsillectomy;
Hx of Peritonsillar Abscess, hx of airway obstruction (sleep apnea) secondary to tonsil hypertrophy, 4-5 episodes of strep pharyngitis in 1yr, chronic sore throat, w/adenopathy for 6 months that is unresponsive to tx.
Adenopathy
Swelling and morbid change in lymph nodes; glandular disease.
Laryngotracheobronchitis (Croup) Definition;
Viral infection causes inflammation & narrowing of the subglottic airway causing obstruction of the subglottic airway & the larynx.
Laryngotracheobronchitis (Croup) Etiology;
Viral inf. & inflammation of the larynx, vocal cords, subglottic part of larynx & nearby structures.
There is inflammation of the vocal cords & trachea w/tracheal & bronchial wall edema, causing narrowing & obstruction to airflow.
Laryngotracheobronchitis (Croup)
Where is maximal narrowing?
The subglottic region
What virus usually causes Laryngotracheobronchitis (Croup)?
Para-influenza virus
(also measles, herpes simplex & adenovirus)
Laryngotracheobronchitis (Croup) S/Sx;
Peaks at 2yrs, barking cough, hoarseness, stridor on inhalation (indicates emergancy),
Laryngotracheobronchitis (Croup) Xrays;
Seen on AP film of neck as "steeple sign".
A lateral film should be taken to R/O D/Dx w/inspiratory stridor, particularly epiglottis.
What does stridor indicate?
Blockage to airway.
Airway is blocked at least 70%
Could be forigne body.
What labs would you order for suspected Laryngotracheobronchitis (Croup)?
CBC - marked leukocytosis, w/increased PMNs.
Laryngotracheobronchitis (Croup) D/Dx;
Epiglottitis, Congenital subglottic Stenosis, Subglottic hemangioma, airway foreign body, Esophageal foreign body, Epiglottis.
What should be the first thing thought of when a pt presents with Subglottic Airway Narrowing?
Epiglottitis-25% of epiglottitis pts have subglottic airway narrowing.
(espectially in non-izz child HIB)
Laryngotracheobronchitis (Croup) Tx;
Relieve obstruction, R/O other causes, Prevention of hypoxia & hypercarbia, Supportive tx. (Decadron 0.6mg/kg to 10m, Nebulizer w/epi.
Epiglottitis Definition;
Disorder caused by inflammation of the cartilage that covers the trachea.
Epiglottitis Etiology;
Haemophilus influenzae group b (Hib)
Epiglottitis S/Sx;
High fever, sore throat, Drooling, tripos position, Beefy red swollen stiff epiglottis that can obstruct breathing, respiratory distress increases rapidly as epiglottis swells, Dysphagia, dysphonia (hot potato voice), distress.
What is the biggest worry w/Epiglottitis?
Spasm may cause the airway to close abruptly.
Putting anything into the mouth could cause spasm.
Death follows withing minutes of laryngeal spasm.
Epiglottitis tx;
Equipment for an emergency tracheostomy should be available during exam.
Epiglottitis Xray;
Thumbprint sign seen on lateral X-ray.
If you think you have time for X-ray.
Epiglottitis S/Sx 4 D's;
Dysphagia
Dysphonia (hot potato voice)
Drooling
Distress
Laryngitis Definition;
Inflammation of the larynx.
Laryngitis Etiology;
Most common cause is viral URI, Bronchitis, Pneumonia, Influenza, Pertussis, Measles, Diphtheria.
Excessive use of voice, Allergic reactions, Inhaling irritating substance (cigarette smoke)
Laryngitis S/Sx;
Hoarseness (Most prominent sx)
Apnonia, tickling, rawness & urge to clear throat, symptoms vary w/severity of inflammation.
(fever, malaise, dysphagia)
Aphonia
Loss of voice.
Laryngitis Tx;
No specific tx for viral Laryngitis.
Tx of acute or chronic bronchitis may relieve laryngitis.
What are benign neoplasms?
May affect any part of the larynx.
Removal restores the voice, the functional integrity of the laryngeal sphincter, & airway.
Benign Neoplasms Etiology;
Juvenile papillomas, Hemangiomas, Fibromas, Chaondromas, Myxomas, Neurofibromas.
Vocal Cord Paralysis Etiology;
Result from; CNS lesions, Intracranial neoplasms, Vascular accidents, Demyelinating dzs, Neoplasms at base of skull, Trauma of the neck, Aortic aneurysm, Mitral stenosis, CA of Thyroid, esophagus, lung or medial structures, Thyroidectomy, Neurotoxins (lead), Neurotoxic inf. (diphtheria), C-spine injury, surger, or viral illness.
Vocal Cord Paralysis S/Sx;
Loss of vocal cord abduction or adduction. May affect phonation, respiration & deglutition & aspiration of fluids & food into trachea, paralyzed cord (2-3mm lateral to the midline may move w/phonation but not inspiration.
deglutition
The act of swallowing.
Unilateral Vocal Cord Paralysis S/Sx;
The airway is usually not obrtructid because the normal cord abducts sufficiently, the voice is hoarse and breathy.
Bilateral Vocal Cord Paralysis S/Sx;
Airway is inadequate, resulting in stridor & dyspnea w/ moderate exertion.
Both cords lie generally w/in 2-3mm of the midline, & the voice is of limited intensity but of good quality.
Vocal Cord Paralysis Management;
The cause must always be sought by; Laryngoscopy, Bronchoscopy, Esophagoscopy, Neurologic exam (enhanced CT of the head, neck & chest),Thyroid gland scan & upper GI.
Vocal Cord Paralysis Tx;
Teflon suspension to bring cords closer together & prevent aspiration, Tracheostomy, Arytenoidectomy (improves airway but may alter voice) Laryngoplasty (external incision in the thyriod cartilage & insertation of material to move the cord medially.