Wheezing - Pediatric - Lecture Slides, Slides of Pediatrics

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All That Wheezes…

What is a “wheeze”

Definitions of obstructive noises

 Stridor

• Harsh noise caused by turbulent flow
• Inspiratory = larynx
• Expiratory = trachea
• Biphasic = fixed lesion in subglottic region

What is a “wheeze”

Definitions of obstructive noises

 Wheeze

• Higher-pitched expiratory noise
• Monophonic, homophonous = large airway = expiratory stridor
• Polyphonic, heterophonous, musical = small airways

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-5 -

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Pre-Inspiration

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-7 -

Inspiration

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-8 -

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End Inspiration

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+30 +

Forced Expiration

Stertor

Causes  Choanal atresia  Mandibular hypoplasia  Macroglossia  Nasal congestion  Adenotonsillar hypertrophy  Pharyngeal insufficiency  Encephalocele  Dermoid of base of tongue  Thyroglossal duct cyst  Lingual thyroid

Inspiratory Stridor

Laryngomalacia

 60% of insp. stridor  90% require no intervention  Improves when prone  Worsens with activity  Worsens over first 1-6mos, then improves  Watch for FTT, apnea, cyanosis

Biphasic Stridor

Causes

 Subglottic stenosis

• Congenital
• Acquired – intubation, croup  Subglottic hemangioma  Laryngeal web  GERD

Biphasic Stridor

Causes

 Croup – acute barky cough, stridor, resp. distress

• Low grade fever
• Rhinorrhea
• Worse at night
• 3mos-3yrs
• Parinfluenza 1-3, RSV, Influenza
• Fall/Winter