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Major Parts of Respiratory System

1. Upper Respiratory Tracta. Noseb. Pharynx (Throat) passage of air, food, and fluids

a. Nasopharynx passage of airb. Oropharynx air, food, fluidsc. Larngyopharynx air, food, fluids

2. Lower Respiratory Tracta. Larnyx (Voice Box) routes air, food, and floods to

proper areas; role in speech

Epiglottis guardian of the airways; protects the superior

opening of larynx; allows passage of food to esophagus

b. Trachea (Windpipe) passageway of air; lined w/cilia to propel debris away from the lungs

c. Bronchio L and R Bronchus - shorter, wider, and straighter;

common site for inhaled foreign objects to be

lodged.

o Bronchioles smaller divisions of bronchid. Lungs (Alveoli is the site of gas exchange between

oxygen and carbon dioxide)

CROUP SYNDROME

Characterized by hoarseness, resonant cough described as barking or brassy (croupy ormetallic) cough, with varying degrees of inspiratory stridor and varying degrees of inspiratorydistress resulting from swelling and obstruction of Larynx.

Types of Croup Syndrome:

1. ACUTE EPIGLOTTIS (SUPRAGLOTTIS) - Does not occur together with LTB

Age Affected 1 8 y/o OR 2 5 y/o

Etiologic Agent Bacteria; Usually H. Influenza

Onset Abrupt, often preceded by a sore throat and RAPIDLY PROGRESSIVE

Major

Symptoms

1. Assumes Tripod Position sitting upright, leaning forward, chin thrust, mouthopen, tongue protruding, drooling of saliva

2. Dysphagia (due to painful swallowing)3. Stridor aggravated in supine position4. Throat is cherry red, inflamed, distinct large, edematous epiglottis5. Muffled voice with frog like croaking sound during inspiration6. HIGH FEVER7. Toxic Appearance8. Increased RR and HR

Treatment 1. Airway Protection2. Antibiotics decreases epiglottal swelling 24 hrs after therapy3. Corticosteroids inflammation; not for long term can cause reverse reaction

(inflammation); body weakness, and moon face or edema

4. Surgerya. Endotracheal Intubation suctioning to remove secretionsb. Tracheostomy surgical opening of trachea to provide alternate route of airto reach lungs

Management 1. Throat Inspection attempted only when STAT ET will be performed2. Dont visualize epiglottis with tongue depressor or throat culture for it can lead to

obstruction of the airway

3. NPO; Strict Aspiration Precaution (SAP)4. No straining during defecation5. No coughing6. No bronchial tapping

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ACUTE LARYNGOTRACHEA BRONCHITIS (LTB)

o Most common of the Croup Syndromeso Narrowing of airway due to inflamed Larynx and Trachea

Age Affected 3 months to 8 years OR

Primarily children < 5 years old

Etiologic Agent Viral (Parainfluenza Virus, Influenza A & B, Mycoplasma Pneumoniae)

Onset Slowly Progressive

Major

Symptoms

o URIo Stridor after days of Coryzao Barking or Brassy Cougho Dyspneao Irritabilityo Restlessnesso Hoarsenesso

LOW GRADE FEVERo Non toxic appearance

Treatment 1. Humidification BID only to prevent overhydration and cause extra secretions2. Ephinephrine

Management 1. Maintain Airway and Provide adequate respiratory exchange2. Managed at Home if MILD CROUP ( no stridor at rest)3. Humidify - Cool Mist Tent4. Nebulized Ephinephrine (Racemic Ephinephrine) decrease edema5. Corticosteroids take effect in 6 hours 12 to 24 hours (ex. Medron Solu Cortex)6. NPO if RR >60 to prevent aspiration and decreases work of breathing 7. Continuous observation and accurate respiratory assessment8. Early Signs of Obstruction nasal flaring, increases RR and HR, retractions

(intercostals, substernal, suprasternal)

9. Promote Rest to conserve energy; avoid strenuous activities10. Proper Positioning11. NO POWDER12. Neck Collar (hot and cold collar brace for temp. relief)

ACUTE SPASMODIC LARYNGITIS

(Spasmodic Group, Twlight Croup, Midnight Croup)

Age Affected 3 months to 3 years

Etiologic Agent Viral

Onset Paroxysomal (Sudden) Attacks of Laryngeal Obstruction @ NIGHTMajor

Symptoms

o URI, Stridor , Barking or Brassy Cough, Dyspnea, Restlessness, Hoarsenesso NO FEVERo PROSTRATION tendency to touch chesto Symptoms awaken child @ night yet disappear during the day; recurs

Treatment Humidify

Management 1. Managed at Home2. Humidify

a. COOL MIST at the childs roomb. WARM MIST BY STEAM from hot running cold water in the bathroom

3. Corticosteroids4. Racemic Ephinephrine for effective dilatation; given if HR is

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