Paeds Vivas · respiratory-sleep-and-airway
Upper-airway obstruction and stridor — branching viva
Branching viva from the definition and localisation of stridor through the Westley grading and management of croup, the do-not-distress approach to the toxic airway, the inhaled foreign body, and the chronic stridor of laryngomalacia.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in the emergency department. The consultant asks you to talk through four children: a two-year-old with a barking cough and stridor, a four-year-old who is toxic, drooling and sitting forward, a toddler who choked on a peanut and now has a unilateral wheeze, and a two-month-old with positional inspiratory stridor since birth who is thriving.
Station opening
Examiner: "Define stridor and explain how it helps you localise the obstruction." [1]
Strong candidate (must-hit)
- Defines stridor as the harsh, monophonic sound of turbulent airflow through a narrowed large airway; explains that the flow phase localises the level — inspiratory stridor is extrathoracic (supraglottic or glottic), biphasic stridor reflects a fixed subglottic lesion, and expiratory stridor is intrathoracic; and states that the first bedside judgement is always whether the child is compensating or exhausting, because a silent chest and falling effort are pre-terminal. [1]
Weak candidate
- "Stridor means the airway is blocked, so we give oxygen and steroids." [1]
References6ShowHide
- [1]Bjornson CL; Johnson DW Croup. Lancet, 2008.PMID 18295000
- [3]Russell KF; Liang Y; O'Gorman K; Johnson DW; Klassen TP Glucocorticoids for croup. Cochrane Database Syst Rev, 2011.PMID 21249651
- [4]Bjornson C; Russell K; Vandermeer B; Klassen TP; Johnson DW Nebulized epinephrine for croup in children. Cochrane Database Syst Rev, 2013.PMID 24114291
- [6]Allen M; Meraj TS; Oska S; et al Acute epiglottitis: Analysis of U.S. mortality trends from 1979 to 2017. Am J Otolaryngol, 2021.PMID 33429180
- [9]Salih AM; Alfaki M; Alam-Elhuda DM Airway foreign bodies: A critical review for a common pediatric emergency. World J Emerg Med, 2016.PMID 27006731
- [10]Thorne MC; Garetz SL Laryngomalacia: Review and Summary of Current Clinical Practice in 2015. Paediatr Respir Rev, 2016.PMID 25802018