Pediatric Advanced Life Support

“UPPER AIRWAY”

Presented By: Mike Pyorala, RCP

UPPER AIRWAY The portion of the respiratory tract that extends from the nostrils or mouth through the larynx.

UPPER AIRWAY

UPPER AIRWAY

UPPER AIRWAY

UPPER AIRWAY

Airway must be clear and patent for successful ventilation.

Position Clear of foreign body Free from injury

.

UPPER AIR OBSTRUCTION

UPPER AIRWAY OBSTRUCTION IS A COMMON CAUSE OF PEDIATRIC EMERGENCY DEPARTMENT VISITS, ACCOUNTING FOR APPROXIMATELY 15% OF ALL CRITICALLY ILL PATIENTS

INFECTIOUS ETIOLOGIES ACCOUNT FOR 90% OF THESE, WITH VIRAL CROUP ACCOUNTING FOR 80%

COMMON PEDIACTRIC UPPER AIR OBSTRUCTIONS

CROUP

EPIGLOTTITIS

CROUP

CROUP AKA: LARYNGOTRACHEOBRONCHITIS

VIRAL MOST COMMON CAUSE OF UPPER

AIRWAY OBSTRUCTION TRANSMITTED VIA RESPIRATORY

ROUTE. PORT OF ENTRY: NOSE & NASOPHARYNX

CROUP

FIRST FEW DAYS- MILD URI, NASAL CONGESTION, COUGH, SORE THROAT

EDEMA SPREADS AS INFECTION SPREADS

HOARSE VOICE & HARSH BARK LIKE COUGH DEVELOPS

STRIDOR USUALLY DEVELOPS AT NIGHT

CROUP

ELEVATED TEMPERATURE

MAY HAVE EXPIRATORY WHEEZING

INSPIRATORY STRIDOR AT REST, NASAL FLARING, RETRACTIONS

CROUP

TREATMENT: HUMIDIFIED AIR OR OXYGEN STERIODS ALBUTEROL RACEMIC EPINEPHRINE- MAX EFFECT SEEN

IN 30 MIN, REBOUND IN 2 HOURS

EPIGLOTTITIS

AKA: SUPRAGLOTTITIS OCCURS IN 3-7 YEARS OF AGE BACTERIAL INFECTION- HEMOPHILUS

INFLUENZAE 1985 VACCINE, BUT VIRUS HAS

MUTATED

EPIGLOTTITIS

EPIGLOTTITIS, VOCAL CORDS, SUPRAGLOTTIC STRUCTURES BECOME INFLAMMED AND EDEMATOUS

NARROWED AIRWAY RESPIRATORY COMPROMISE INSPIRATORY AIR OCCLUSION

NORMALLY OCCURS PRIOR TO TOTAL OCCLUSION

EPIGLOTTITIS

MAY ALSO BE CAUSED BY: HOT LIQUIDS FOREIGN BODY INGESTION INHALATION INJURIES

EPIGLOTTITIS

SYMPTOMS: VERY SUUDEN ONSET, RAPID PROGRESSON MUFFLED VOICE OR CRY MINIMAL COUGH FEVER SORE THROAT DROOLING

REVIEW CROUP

VOICE- HOARSE

COUGH- BARKING

FEVER- YES

SALIVA- MINIMAL

NECK SWELLING-

MINIMAL

EPIGLOTTITIS VOICE- MUFFLED

COUGH- USUALLY NONE

FEVER- YES

SALIVA- LOTS

NECK SWELLING- LOTS

REVIEW CROUP

BEGINS- SLOWLY

SEASON- AUTUMN

TIME- EVENING / NIGHT

EPIGLOTTITIS

BEGINS SUDDENLY

SEASON- ALL YEAR

TIME- ALL DAY

Respiratory Arrest

Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.

Only 10% of children who progress to cardiopulmonary arrest are successfully resuscitated.

EPIGLOTTITIS

SYMPTOMS: RETRACTIONS NOISY, HIGH PITCHED SQUEAKY

INHALATIONS CYANOSIS ODD HEAD POSTURE (SNIFFING POSITION)

EPIGLOTTITIS

WHAT CAUSES AIRWAY OBSTRUCTION?

EPIGLOTTITIS

WHAT CAUSES AIRWAY OBSTRUCTION? FATIGUE

LARYNGOSPASM

POOLED SECRETIONS

PROGRESSIVE SWELLING OF SUPRAGLOTTIC STRUCTURES

EPIGLOTTITIS

TREATMENT:

AIRWAY MANAGEMENT HIGH FLOW HUMIDIFIED OXYGEN TO MAINTAIN

SATURATION POSITIONOF COMFORT NOISY, HIGH PITCHED SQUEAKY INHALATIONS CYANOSIS ODD HEAD POSTURE (SNIFFING POSITION) HOT LIQUIDS FOREIGN BODY INGESTION INHALATION INJURIES

REVIEW CROUP

VOICE- HOARSE

COUGH- BARKING

FEVER- YES

SALIVA- MINIMAL

NECK SWELLING-

MINIMAL

EPIGLOTTITIS VOICE- MUFFLED

COUGH- USUALLY NONE

FEVER- YES

SALIVA- LOTS

NECK SWELLING- LOTS

REVIEW CROUP

BEGINS- SLOWLY

SEASON- AUTUMN

TIME- EVENING / NIGHT

EPIGLOTTITIS

BEGINS SUDDENLY

SEASON- ALL YEAR

TIME- ALL DAY

Respiratory Arrest

Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.

Only 10% of children who progress to cardiopulmonary arrest are successfully resuscitated.

Pediatric Advanced Life Support

“UPPER AIRWAY”

Presented By: Mike Pyorala, RCP

THANK YOU !