Fixed narrowing of the airway at birth- certain conditions can cause a child to be born with a narrowed airway.
This can occur at multiple points in the respiratory tract. An example of this includes congenital subglottic stenosis. Abnormal swelling or a growth within the respiratory tract can cause obstruction. Swelling or scarring can cause acquired subglottic stenosis. This could also include a cyst or vascular birthmark hemangioma in the airway. A foreign object or food item can be aspirated sucked into the airway and can cause obstruction and noisy breathing.
Floppy tissues in the respiratory tract can cause noisy breathing. This is because of collapse of these tissues into the airway. This can partially obstruct airflow and cause collapse of surrounding tissues. Examples of this include pharyngomalacia, laryngomalacia , tracheomalacia , and bronchomalacia.
Compression of the airway from an external structure. This can be due to a crossing blood vessel, the heart, or other structures outside of the airway that put pressure on the airway and cause collapse. Spasm of the airways related to underlying medical conditions, like asthma, or due to irritants in the environment. Problems with the vocal cords moving normally.
How Is Noisy Breathing Evaluated? What Is the Treatment for Noisy Breathing? Blog Noisy Breathing in Kids Is your child a noisy breather? Find out why — and what to do about it. Condition Laryngomalacia Laryngomalacia is the most common cause of noisy breathing in infants.
Therefore, urgent hospitalization, imaging, and intervention are required. If it caused by a foreign body urgent removal of the foreign body by bronchoscopy is indicated. Sometimes if the cause is not reversible immediately, temporary insertion of an endotracheal tube is required. These patients can get completely respiratory obstruction and death in few minutes. Therefore, they should be managed by experienced people in the health care team very carefully.
Wheezing is a common clinical sign which occurs in multiple smaller airway obstructions such as in bronchospasms. This is a cardinal sign in Asthma. The wheezing sound is generated by the passage of air through multiple narrowed airways during expiration.
It causes trapping of air proximal to the narrowing and therefore chest tightness. Wheezing is a common occurring in the childhood especially among the children with atopic or allergic tendencies.
Bronchospasms are caused by smooth muscle contraction as well as from mucosal edema and accumulation of secretions in the airways. Did the infant have any neck surgeries for congenital abnormalities? Was there a recent upper respiratory tract infection? Asking questions like these in the prehospital setting can expedite the care given in the ambulance and prepare ED staff for the next steps. Such questions may help save the life of an infant or child.
Like stridor, wheezing is an airway sound resulting from obstruction. Obstruction of lower airway tracts causes turbulent airflow that makes the characteristic sound most often heard in children with asthma. As in stridor, the causes of wheezing are numerous Table III , varying from inflammation to infection, from neoplasms to cardiac, from congenital to traumatic in nature.
Has the patient had valve replacement in the past? Is there a family history of asthma? Does the patient have known congenital defects? Has the patient ever had episodes of wheezing in the past? Just as in stridor, questions like these can elicit faster and more directed diagnosis and treatment. In almost every case of stridor, prehospital care will consist of airway support and oxygenation alone.
For example, if you give a particular wheezing pediatric patient nebulized beta2-agonist and oxygen prior to learning that she has a recent history of valve replacement, her condition will likely not improve.
In this particular example, the child may be suffering from congestive heart failure CHF , caused by a deficient or failing valve.
In CHF, there is a leakage of fluid from pulmonary vessels, increasing the pressure around bronchioles and causing wheezing from the resultant narrowing of the lumens. Unless a child is known to be in CHF, the inflammatory causes of lower airway obstruction should be assumed and proper treatments administered. Asthma, the epitome of wheeze-inducing diseases, causes obstruction in the lower, small airways. Treatment is usually very effective and is aimed at both pharmacologically dilating the airways beta2-agonists and diminishing inflammation steroids.
In general, prehospital treatment of pediatric wheezing is aimed at the most likely cause: asthma or bronchiolitis, an inflammatory condition usually caused by Respiratory Syncytial Virus RSV and seen most often in infants 2—9 months of age. Both are clinically indistinguishable and treated with beta2-agonists and oxygen if hypoxic.
If a history of asthma is known, some EMS agencies also initiate oral or inhaled steroid treatments. As noted above, wheezing caused by CHF is best treated with diuretics and oxygen. Since most wheezing is caused by asthma or bronchiolitis, it should be treated as such initially. Perhaps the most stressful patients that prehospital caregivers encounter are children in respiratory distress.
The fretfulness of the parents, as well as the distress and usually uncooperative nature of the patient, all combine to create a situation laden with anxiety.
By knowing the anatomy causing the respiratory noises, prehospital caregivers can discover the essence of the problem and quickly implement proper treatment. Sign in. EMS World Expo. Current Issue. Issue Archives. Start Print Subscription. Renew Print Subscription. Start Digital Subscription. Patient Care. Expo on Demand. CE Articles. Online Product Guide. Contact Us.
Advisory Board. About Us. Copied to clipboard. Anatomy When painting a mental picture of the pediatric airway, it is important to divide the entire path into separate areas. Stridor Stridor is defined as a harsh, vibratory sound of varying pitch caused by turbulent airflow through an obstructed airway.
In the prehospital care setting, it is important to recognize a few key concepts relating to the treatment of stridor: 1. Wheezing Like stridor, wheezing is an airway sound resulting from obstruction.
Conclusion Perhaps the most stressful patients that prehospital caregivers encounter are children in respiratory distress. Rapidly increasing stridor in a week-old infant. J Peds , Cochran D. Pitfalls in the management of children with wheeze. The Practitioner —, Myasthenic crisis presenting as isolated vocal cord paralysis.
Am J Emerg Med 18 2 —, Cupitt JM. Not all that wheezes is asthma. Anaesthesia 55 12 , Dominguez OJ. Emerg Med Serv 31 4 , Episodic stridor with latex nipple use in a 2-month-old infant. Ann Emerg Med —, Halterman JS. All that wheezes: The challenges of a common pediatric disease. Ped Ann —85, Diagnosis of stridor in children.
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