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Subglottic Stenosis
Aka: Subglottic Stenosis
- Definitions
- Subglottic Stenosis
- Congenital or acquired narrowing of the airway immediately below the level of the Larynx (cricoid cartilage level)
- Pathophysiology
- Subglottic airway is the narrowest portion of the upper airway
- Most common cause is prior Premature Infants with history of prolonged intubation (scar forms in subglottis)
- Epidemiology
- Rare aside from Premature Infants who underwent prolonged intubation
- Causes
- Congenital Anomaly
- Acquired
- Airway Trauma
- Prolonged neonatal intubation (postintubation stenosis)
- Gastroesophageal Reflux disease
- Infectious
- Syphilis
- Tuberculosis
- Typhoid Fever
- Diphtheria
- Symptoms
- Infants and young children
- Persistent or recurrent Stridor
- Older children and adults
- Dyspnea on exertion
- Diagnostics
- Pulmonary Function Tests
- Typically demonstrates a fixed upper airway obstruction
- Management
- Non-Emergent Presentation
- Otolaryngology Consultation in all suspected cases
- Endoscopic dilation or surgical repair
- Emergency Airway Management (respiratory distress)
- Early emergent Consultation with ENT for surgical Tracheostomy
- Temporize airway
- Albuterol Nebulizer (with or without Ipratropium Bromide in Duoneb)
- Nebulized racemic epinephrine
- Calm Patient
- Sub-dissociative dose Ketamine
- Consider full-dissociative dose Ketamine
- Other measures
- Tracheal Jet Ventilation
- Heliox
- References
- Guest and Friedman in Herbert (2020) EM Rap 20(12): 1-2
- References
- Dahan, Campbell and Melville (2020) Crit Dec Emerg Med 34(11): 3-10