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2393957418070Retropharyngeal Abscess00Retropharyngeal Abscess15354307416800From base of skull to T2 / tracheal bifurcation; potential space anterior to prevertebral fascia; more likely to extend into mediastinum in adultCauses: in children, due to suppuration of lymph node; in adult, due to extension from adjacent site (eg. Ludwig’s angina); usually polymicrobial; S pyogenes, S aureus, S viridans, anaerobes, G-ive rods, staph bacteroides, pepto- streptococcus; most common traumatic cause when child falls with FB in mouthAge: <4yrsOnset: URTI insidious over 2-3/7Symptoms: inspiratory stridor when severe, neck stiffness and hyperextension, torticollis, hot potato voice, drooling, dysphagia; NO cough; fever absent in >10%; pleuritic chest pain ominious as means has spread to mediastinum; stridor and neck oedema more likely in childrenXR: thickened bulging retropharyngeal soft tissue (at C2 = 2x diameter C2, or >50% width of C4)Investigations: CT (idenitifies abscess from cellulitis, shows anatomic spaces involved, helps plan OT, sensitivity 100%Management: antibiotics (cefoxitin 2g IV), steroids may help decrease oedema and prevent progression; I+D00From base of skull to T2 / tracheal bifurcation; potential space anterior to prevertebral fascia; more likely to extend into mediastinum in adultCauses: in children, due to suppuration of lymph node; in adult, due to extension from adjacent site (eg. Ludwig’s angina); usually polymicrobial; S pyogenes, S aureus, S viridans, anaerobes, G-ive rods, staph bacteroides, pepto- streptococcus; most common traumatic cause when child falls with FB in mouthAge: <4yrsOnset: URTI insidious over 2-3/7Symptoms: inspiratory stridor when severe, neck stiffness and hyperextension, torticollis, hot potato voice, drooling, dysphagia; NO cough; fever absent in >10%; pleuritic chest pain ominious as means has spread to mediastinum; stridor and neck oedema more likely in childrenXR: thickened bulging retropharyngeal soft tissue (at C2 = 2x diameter C2, or >50% width of C4)Investigations: CT (idenitifies abscess from cellulitis, shows anatomic spaces involved, helps plan OT, sensitivity 100%Management: antibiotics (cefoxitin 2g IV), steroids may help decrease oedema and prevent progression; I+D58407307418070002393955815330Peritonsillar Abscess00Peritonsillar Abscess15443205815330Causes: polymicrobial; S pyogenes, S aureus, anaerobes, Grp A beta- haemolytic strep, H influenzaAge: 10-18yrsOnset: pharyngitis; hot potato voice, drooling, worse supine, dysphagia; NO stridor, cough; trismus; deviation of uvula away; <10% bilateralXR: enlarged peritonsillar soft tissueManagement: drainage, antibiotics; single high dose PO steroid may help00Causes: polymicrobial; S pyogenes, S aureus, anaerobes, Grp A beta- haemolytic strep, H influenzaAge: 10-18yrsOnset: pharyngitis; hot potato voice, drooling, worse supine, dysphagia; NO stridor, cough; trismus; deviation of uvula away; <10% bilateralXR: enlarged peritonsillar soft tissueManagement: drainage, antibiotics; single high dose PO steroid may help526478558712100047986953872230002393953709035Bacterial Tracheitis00Bacterial Tracheitis15360653709035Causes: staph aureus > Strep pneumoniae, H influenzae, strep pyogenes, moraxella catarrhalis, anaerobes; often 2Y to 1Y viral URTIAge: any age, mean 5-8yrsOnset: 2-7/7 URTI suddenly worsens over 8-12hrsSymptoms: inspiratory and expiratory stridor, productive cough, raspy voice; NO drooling / effect of positioning / dysphagia; toxic appearanceXR: subglottic narrowing, irregular tracheal marginsInvestigations: cultures and gram stainManagement: sedation, intubation, bronchoscopy; cephalosporin and clindamycin (?add in vanc)00Causes: staph aureus > Strep pneumoniae, H influenzae, strep pyogenes, moraxella catarrhalis, anaerobes; often 2Y to 1Y viral URTIAge: any age, mean 5-8yrsOnset: 2-7/7 URTI suddenly worsens over 8-12hrsSymptoms: inspiratory and expiratory stridor, productive cough, raspy voice; NO drooling / effect of positioning / dysphagia; toxic appearanceXR: subglottic narrowing, irregular tracheal marginsInvestigations: cultures and gram stainManagement: sedation, intubation, bronchoscopy; cephalosporin and clindamycin (?add in vanc)2393952210435Epiglottitis00Epiglottitis15443202209800Causes: strep pneumoniae, staph aureus, H influenzaeAge: mostly 1-7yrsOnset: sudden over hoursSymptoms: inspiratory stridor, hot potato muffled voice, worse supine, prefer erect chin forward, drooling, dysphagia; NO coughXR: enlarged epiglottis and aryepiglottic folds00Causes: strep pneumoniae, staph aureus, H influenzaeAge: mostly 1-7yrsOnset: sudden over hoursSymptoms: inspiratory stridor, hot potato muffled voice, worse supine, prefer erect chin forward, drooling, dysphagia; NO coughXR: enlarged epiglottis and aryepiglottic folds6047740221043500243840963930Croup00Croup1543685963930Causes: parainfluenza virus, RSV, rhinovirusAge: peak 1-2yrsOnset: 1-3/7Symptoms: inspiratory and expiratory stridor, seal like cough, hoarse voice, occasional dysphagia; NO effect of positioning, droolingXR: subglottic narrowing steeple sign00Causes: parainfluenza virus, RSV, rhinovirusAge: peak 1-2yrsOnset: 1-3/7Symptoms: inspiratory and expiratory stridor, seal like cough, hoarse voice, occasional dysphagia; NO effect of positioning, droolingXR: subglottic narrowing steeple sign605155096393000246380330200Stridor00Stridor 15322551845945Angioedema, bilateral vocal cord paralysis, laryngeal spasm post-extubation / aspirationSubglottic stenosis: Post-ETT, Wegener’s granulomatosis, collagen vascular disorders, URTILaryngeal trauma: endolaryngeal mucosal tears, cartilaginous #, dislocation of cricoarytenoid joint, laryngeo-tracheal separation bleeding, bruits do flexible laryngoscopy if no gross disruption or mucosa or displacement of arytenoids or lumen, can treat with ETT; if lumen can’t be seen / laryngeo- tracheal separation urgent awake trachy entering low (@ 4th-5th tracheal ring), avoid cricothyroidotomy (may further injure subepiglottis, landmarks obliterated)00Angioedema, bilateral vocal cord paralysis, laryngeal spasm post-extubation / aspirationSubglottic stenosis: Post-ETT, Wegener’s granulomatosis, collagen vascular disorders, URTILaryngeal trauma: endolaryngeal mucosal tears, cartilaginous #, dislocation of cricoarytenoid joint, laryngeo-tracheal separation bleeding, bruits do flexible laryngoscopy if no gross disruption or mucosa or displacement of arytenoids or lumen, can treat with ETT; if lumen can’t be seen / laryngeo- tracheal separation urgent awake trachy entering low (@ 4th-5th tracheal ring), avoid cricothyroidotomy (may further injure subepiglottis, landmarks obliterated)2324101846580Other Causes00Other Causes232410529590Foreign Body Aspiration00Foreign Body Aspiration1532255529590Age: usually <5yrs (80% <3yrs)Onset: immediate (delayed possible)Symptoms: presence of stridor, positional changing, voice change, cough position dependent; choking episode most predictiveXR: radioopaque density (>75% FB’s in those <3yrs are radiolucent), ball-valve effect, segmented atelectasis, consolidation, emphysema, mediastinal shift away; 80-90% found in bronchi; XR normal in >50% tracheal FB’s; inspiratory and expiratory films help; C6 most common level in child00Age: usually <5yrs (80% <3yrs)Onset: immediate (delayed possible)Symptoms: presence of stridor, positional changing, voice change, cough position dependent; choking episode most predictiveXR: radioopaque density (>75% FB’s in those <3yrs are radiolucent), ball-valve effect, segmented atelectasis, consolidation, emphysema, mediastinal shift away; 80-90% found in bronchi; XR normal in >50% tracheal FB’s; inspiratory and expiratory films help; C6 most common level in child ................
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