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Pediatric Advanced Life Support “UPPER AIRWAY” Presented By: Mike Pyorala, RCP.

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Presentation on theme: "Pediatric Advanced Life Support “UPPER AIRWAY” Presented By: Mike Pyorala, RCP."— Presentation transcript:

1 Pediatric Advanced Life Support “UPPER AIRWAY” Presented By: Mike Pyorala, RCP

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

3 UPPER AIRWAY

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8 Airway must be clear and patent for successful ventilation.  Position  Clear of foreign body  Free from injury.

9 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%

10 COMMON PEDIACTRIC UPPER AIR OBSTRUCTIONS CROUP EPIGLOTTITIS

11 CROUP CROUP AKA: LARYNGOTRACHEOBRONCHITIS VIRAL MOST COMMON CAUSE OF UPPER AIRWAY OBSTRUCTION TRANSMITTED VIA RESPIRATORY ROUTE. PORT OF ENTRY: NOSE & NASOPHARYNX

12 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

13 CROUP ELEVATED TEMPERATURE MAY HAVE EXPIRATORY WHEEZING INSPIRATORY STRIDOR AT REST, NASAL FLARING, RETRACTIONS

14 CROUP TREATMENT:  HUMIDIFIED AIR OR OXYGEN  STERIODS  ALBUTEROL  RACEMIC EPINEPHRINE- MAX EFFECT SEEN IN 30 MIN, REBOUND IN 2 HOURS

15 EPIGLOTTITIS AKA: SUPRAGLOTTITIS OCCURS IN 3-7 YEARS OF AGE BACTERIAL INFECTION- HEMOPHILUS INFLUENZAE 1985 VACCINE, BUT VIRUS HAS MUTATED

16 EPIGLOTTITIS EPIGLOTTITIS, VOCAL CORDS, SUPRAGLOTTIC STRUCTURES BECOME INFLAMMED AND EDEMATOUS NARROWED AIRWAY RESPIRATORY COMPROMISE INSPIRATORY AIR OCCLUSION NORMALLY OCCURS PRIOR TO TOTAL OCCLUSION

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

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

19 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

20 REVIEW CROUP  BEGINS- SLOWLY  SEASON- AUTUMN  TIME- EVENING / NIGHT EPIGLOTTITIS  BEGINS SUDDENLY  SEASON- ALL YEAR  TIME- ALL DAY

21 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.

22 EPIGLOTTITIS SYMPTOMS:  RETRACTIONS  NOISY, HIGH PITCHED SQUEAKY INHALATIONS  CYANOSIS  ODD HEAD POSTURE (SNIFFING POSITION)

23 EPIGLOTTITIS WHAT CAUSES AIRWAY OBSTRUCTION?

24 EPIGLOTTITIS WHAT CAUSES AIRWAY OBSTRUCTION?  FATIGUE  LARYNGOSPASM  POOLED SECRETIONS  PROGRESSIVE SWELLING OF SUPRAGLOTTIC STRUCTURES

25 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

26 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

27 REVIEW CROUP  BEGINS- SLOWLY  SEASON- AUTUMN  TIME- EVENING / NIGHT EPIGLOTTITIS  BEGINS SUDDENLY  SEASON- ALL YEAR  TIME- ALL DAY

28 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.

29 Pediatric Advanced Life Support “UPPER AIRWAY” Presented By: Mike Pyorala, RCP THANK YOU !


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