Approach/management of patient with Stridor

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

• Serum creatinine and urea

Non-pharmacological treatment

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: Epinephrine (adrenaline) by nebulisation 0.5 ml/kg of 1:1000 (maximum 5 ml).

AND

B: dexamethasone (PO/IV/IM) 0.15–0.6 mg/kg stat (maximum 10 mg).

OR

• Treat the underlying cause (for example, adrenaline IM for anaphylaxis, antibiotics for epiglottitis or abscess, removal of a foreign body).

• If there are signs of shock, give IV fluids: 0.9% sodium chloride 20 ml/kg (adults 1–2 litres), then reassess.

• Unstable airway: call for surgical/anaesthetic help for an advanced or surgical airway; if stable, consider imaging or direct visualisation of the larynx (fibreoptic or video laryngoscope).

Referral

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