Major Parts of Respiratory System 1. Upper Respiratory Tract a. Nose b.

Pharynx (Throat) passage of air, food, and fluids a. Nasopharynx passage of air b. Oropharynx air, food, fluids c. Larngyopharynx air, food, fluids Lower Respiratory Tract 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. c. Trachea (Windpipe) passageway of air; lined w/ cilia to propel debris away from the lungs Bronchi o L and R Bronchus - shorter, wider, and straighter; common site for inhaled foreign objects to be lodged. o Bronchioles smaller divisions of bronchi Lungs (Alveoli is the site of gas exchange between oxygen and carbon dioxide)

2. a.

d.

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

Types of Croup Syndrome: 1. ACUTE EPIGLOTTIS (SUPRAGLOTTIS) - Does not occur together with LTB Age Affected Etiologic Agent Onset Major Symptoms 1 8 y/o OR 2 5 y/o Bacteria; Usually H. Influenza Abrupt, often preceded by a sore throat and RAPIDLY PROGRESSIVE 1. Assumes Tripod Position sitting upright, leaning forward, chin thrust, mouth open, tongue protruding, drooling of saliva 2. Dysphagia (due to painful swallowing) 3. Stridor aggravated in supine position 4. Throat is cherry red, inflamed, distinct large, edematous epiglottis 5. Muffled voice with frog like croaking sound during inspiration 6. HIGH FEVER 7. Toxic Appearance 8. Increased RR and HR 1. Airway Protection 2. Antibiotics decreases epiglottal swelling 24 hrs after therapy 3. Corticosteroids inflammation; not for long term can cause reverse reaction (inflammation); body weakness, and moon face or edema 4. Surgery a. Endotracheal Intubation suctioning to remove secretions b. Tracheostomy surgical opening of trachea to provide alternate route of air to reach lungs 1. Throat Inspection attempted only when STAT ET will be performed 2. 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 defecation 5. No coughing 6. No bronchial tapping

Treatment

Management

ACUTE LARYNGOTRACHEA BRONCHITIS (LTB) o o Most common of the Croup Syndromes Narrowing of airway due to inflamed Larynx and Trachea 3 months to 8 years OR Primarily children < 5 years old Viral (Parainfluenza Virus, Influenza A & B, Mycoplasma Pneumoniae) Slowly Progressive o URI o Stridor after days of Coryza o Barking or Brassy Cough o Dyspnea o Irritability o Restlessness o Hoarseness o LOW GRADE FEVER o Non toxic appearance 1. Humidification BID only to prevent overhydration and cause extra secretions 2. Ephinephrine 1. Maintain Airway and Provide adequate respiratory exchange 2. Managed at Home if MILD CROUP ( no stridor at rest) 3. Humidify - Cool Mist Tent 4. Nebulized Ephinephrine (Racemic Ephinephrine) decrease edema 5. 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 assessment 8. Early Signs of Obstruction nasal flaring, increases RR and HR, retractions (intercostals, substernal, suprasternal) 9. Promote Rest to conserve energy; avoid strenuous activities 10. Proper Positioning 11. NO POWDER 12. Neck Collar (hot and cold collar brace for temp. relief) ACUTE SPASMODIC LARYNGITIS (Spasmodic Group, Twlight Croup, Midnight Croup) Age Affected Etiologic Agent Onset Major Symptoms Treatment Management 3 months to 3 years Viral Paroxysomal (Sudden) Attacks of Laryngeal Obstruction @ NIGHT o URI, Stridor , Barking or Brassy Cough, Dyspnea, Restlessness, Hoarseness o NO FEVER o PROSTRATION tendency to touch chest o Symptoms awaken child @ night yet disappear during the day; recurs Humidify 1. Managed at Home 2. Humidify a. COOL MIST at the childs room b. WARM MIST BY STEAM from hot running cold water in the bathroom 3. Corticosteroids 4. Racemic Ephinephrine for effective dilatation; given if HR is

Age Affected Etiologic Agent Onset Major Symptoms

Treatment Management

ACUTE TRACHEITIS \Age Affected Etiologic Agent Onset Major Symptoms Treatment 1 6 years old Bacteria, usually Streptococcus Pneumoniae Moderately Progressive o URI, Stridor , Barking or Brassy Cough o HIGH FEVER o Purulent Discharge o Does not respond to LTB Theraphy Antibiotics