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

EPIGLOTTITIS

VOICE- HOARSE

VOICE- MUFFLED

COUGH- BARKING


FEVER- YES

COUGH- USUALLY
NONE
FEVER- YES

SALIVA- MINIMAL

SALIVA- LOTS

NECK SWELLINGMINIMAL

NECK SWELLINGLOTS
REVIEW

CROUP

EPIGLOTTITIS

BEGINS- SLOWLY

BEGINS SUDDENLY

SEASON- AUTUMN

SEASON- ALL YEAR

TIME- EVENING /
NIGHT

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

EPIGLOTTITIS

VOICE- HOARSE

VOICE- MUFFLED

COUGH- BARKING


FEVER- YES

COUGH- USUALLY
NONE
FEVER- YES

SALIVA- MINIMAL

SALIVA- LOTS

NECK SWELLINGMINIMAL

NECK SWELLINGLOTS
REVIEW

CROUP

EPIGLOTTITIS

BEGINS- SLOWLY

BEGINS SUDDENLY

SEASON- AUTUMN

SEASON- ALL YEAR

TIME- EVENING /
NIGHT

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.
THANK YOU !
Pediatric Advanced Life
Support
“UPPER AIRWAY”
Presented By: Mike Pyorala, RCP