Approach to Stridor

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Stridor  is  an  abnormal,  high-pitched  sound  produced  by  turbulent  airflow  through  a  partially  obstructed airway. Stridor is a dangerous finding and may indicate imminent airway obstruction. It  can be inspiratory, expiratory or biphasic. 

Clinical presentation: 

  • Hypoxia
  • Respiratory distress
  • Altered mental status
  • Inability to speak
  • Inability to swallow

Differential diagnoses 

  • Infectious causes - croup, epiglottitis, peri-tonsillar abcess, retropharyngeal abcess 
  • Non-infectious causes - Foreign  body  obstruction,  burns,  trauma,  anaphylaxis,  malignancy, laryngotracheomalacia, stenosis 

Investigations 

Blood gases analysis, Lateral neck X ray (for foreign body, masses or soft tissue swelling), CXR  (foreign body, evidence of aspiration), CT- scan, Blood Sugar, Lactate, Electrolyte analysis and/or  Serum creatinine and urea  

Non pharmacological  

Keep  the  patient  calm  by  allowing  the  patient  to  assume  their  most  comfortable  position.  Give  oxygen if there are signs of increased work of breathing. 

Pharmacological treatment 

A: adrenaline (nebulization) 0.5mls/kg 

AND  

A:  prednisolone (PO) 1-2mg/kg stat 

OR 

D: dexamethasone (PO) 0.6mg/kg stat 

Note 

Administer IV fluids (if signs of shock) – refer section on the management of shock 

Referral: All patients with stridor whom the cause has not yet been established must be referred to  higher health facilities