CS / ET
Croup (Narrowing of the subglottic airway) : Steeple sign
however, the steeple sign may be present in normal children
and can be absent in up to 50% of those with croup
Epiglottitis : Thumb sign
Croup : 6 months to 3 years old
Croup
Viral laryngotracheobronchitis
Virus : Parainfluenza, rhinovirus, RSV, influenzae
1 to 3 days of nasal congestion, rhinorrhea, cough, and low-grade fever
Harsh barking cough, hoarse voice, and stridor
Most croup is self-limited and short in duration, resolving spontaneously within 3 days
Dexa PO/IM, Bosmin INHL
不管嚴重度都要用一次 Steroid
中度以上要吸收 bosmin
Children who have received nebulized epinephrine
should be observed in the ED for 3 to 4 hours after administration.
All patients with croup, whether mild, moderate, or severe,
benefit from the administration of oral steroids as a one-time dose
Dexamethasone is equally effective given parenterally or orally.
Currently, a single dose of 0.6 mg/kg PO
of the oral dexamethasone preparation is recommended.
The onset of action for oral dexamethasone
is generally 4 to 6 hours after oral administration,
but effects can be seen within 1 hour.
Dexamethasone for croup : 只要給一次藥物 !
Moderate to severe croup : 0.6 mg/kg IM/IV/PO
Mild croup : Consider 0.15 mg/kg
Oral as effective as IM.
Maximum dosage in children : 10 mg
Uptodate : 0.6 mg/kg, maximum of 16 mg
L-epinephrine : 0.5 mL/kg per dose (maximum of 5 mL)
using the 1 mg/mL strength (1:1000 dilution)
It is given via nebulizer over 15 minutes.
10kg : 5ml = 5 amp Bosmin INHL
Some authors suggest the nebulized epinephrine dose should be
2.5 mg per dose diluted with 4-5 ml NS in patients less than 4 years.
In > 4 y/o 5mg dose is sufficient with no more dilution.
通常為了避免腎上腺素的副作用 (心跳加快, 肌肉顫抖)
會間隔 30 分鐘再使用下一次藥物
Give nebulized epinephrine for moderate to severe croup,
primarily those with stridor at rest;
mild croup generally does not require epinephrine.
There is theoretical risk of worsening upper airway obstruction
with β-agonist use in croup,
as β-receptors in the vasculature cause vasodilation
(as compared to the vasoconstrictive α effects of epinephrine),
which may worsen upper airway edema in croup.
Therefore, β-agonists are not recommended for treatment of croup.
Intubation should be performed using an
endotracheal tube 0.5 to 1 mm smaller than normally used
or the patient’s size given the upper airway edema.
https://www.mdcalc.com/westley-croup-score
Epiglottitis :
Mean age 6 - 12 years
Bacteria : Hib, streptococcal and staphylococcal
Abrupt onset of fever, stridor, drooling, and sore throat.
Cough is often absent, and the voice may be muffled
Dysphagia, Hoarseness, Dyspnea
Sniff / Tripod position
急性會厭炎好發於 40 - 50 歲的成人以男性較多,
視情況給予類固醇注射以及吸入性藥物治療, 可以幫助會厭消腫
- Nebulized l-epinephrine to decrease airway edema
- Awake, fiberoptic nasotracheal intubation under conscious sedation
should be considered in the spontaneously breathing patient.
The decision to administer paralytics must be accompanied
by absolute certainty that intubation will be successful
- Ceftriaxone and vancomycin
- Steroids are often used to decrease mucosal edema of the epiglottis
Acute epiglottitis in adults
- Ceftriaxone + metranidazole
- Solu medrol STAT and Q12H
Epiglottitis (發炎 -- > bacteria ---> fever)
要流口水所以有 Sniff / Tripod position
細菌所以要 anti
兩個都有 stidor
Croup 是 Virus
Cough 咳到 hoarseness
治療是 dexa, bosmin
Croup 哮吼症又稱為喉氣管炎
好發在六個月~三歲的孩子
咽喉會厭以及聲帶附近發炎腫脹, 導致呼吸道阻塞, 呼吸困難
https://www.youtube.com/watch?v=Qbn1Zw5CTbA
通常是先出先一般感冒症狀後, 大約 4-5天左右因為喉頭腫脹才出現哮吼症狀
不過大人因為呼吸道夠粗一般症狀較輕, 可能只會突然失聲
很少會呼吸困難
幼兒因為喉頭較細, 呼吸困難的現象就更明顯
文章標籤
全站熱搜
留言列表
CV (7)
