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Stridor

 

Definitions in stridor

  • Stridor is a harsh, high-pitched respiratory sound, caused by obstruction of the upper airways at or below the level of the larynx
    • Stridor is worth with distress/crying, particularly in children
    • Expiratory stridor: intrathoracic tracheal cause (as the increase in intrathoracic pressure on expiration makes the obstruction worse)
    • Biphasic stridor: subglottic cause
    • Inspiratory stridor: Supraglottic/glottic origin
  • Stertor is pharyngeal and worse with sleep

 

Causes of stridor (think of intraluminal, luminal and extraluminal causes)

  • Intaluminal
    • Foreign body
    • Vocal cord palsy
  • Luminal
    • Supraglottitis/epiglottitis
    • Croup
    • Malignancy
    • Papillomatosis
  • Extraluminal
    • Airway trauma
    • Compression e.g. from thyroid or malignancy external to airway
    • Cricoarytenoid fixation in rheumatoid

 

Common causes of stridor in children

  • Laryngomalacia
  • Croup
  • Foreign body
  • Epiglottitis
  • Vocal cord palsy
  • Laryngeal web/cleft
  • Subglottic stenosis
  • Respiratory papillomatosis

 

History and examination in stridor

  • Adults and children
    • Severity
    • Onset
    • Recent changes
    • Neck lumps
    • Recent infections
    • Previous intubations
    • Change in voice
  • Children
    • Change in cry
    • Feeding difficulty
  • Adults
    • Malignancy screening questions: Smoking, drinking, weight loss, dysphagia
  • NB. Beware of signs of respiratory distress, cyanosis or drooling

 


Respiratory examination from Oxford Medical Videos

 

Management of stridor

  • Stridor is an emergency
    • Manage with ABCDE approach
    • Call an anaesthetist early
    • Get the patient to a safe place and get help from the ENT team with experienced anaesthetist
  • In children, DO NOT distress in any way them as this can compromise the airway
  • Medical management of the airway
    • IV steroids
      • Dexamethasone 8mg TDS to start
    • Nebulised adrenaline
      • 1ml 1:1000 made up to 5ml with normal saline
  • At some point the cords will need to be visualised either with a flexible nasendoscopy if safe to do so else under general anaesthetic
  • Emergency airway options include
    • 1) Intubation
    • 2) Jet ventilation
    • 3) Cricothyroidotomy
    • 4) Tracheostomy

 

Click here to download free teaching notes on stridor: Stridor

Perfect revision for medical students, finals, OSCEs and MRCP PACES