7/12/2013

7/12/2013

Answers:

A child with stridor presents to the ED.  A plain film of the neck is obtained which shows a "thumbprint" sign. What is the most likely diagnosis?
A) Laryngotracheobronchitis
B) Supraglottitis
C) Bacterial Tracheitis
D) Foreign Body
E) All of the above
F) None of the above
On plain film croup demonstrates a "steeple" sign, bacterial tracheitis shows a narrowing of the tracheal lumen and epiglottitis/supraglottitis has a "thumbprint" sign.  As epiglottitis has a high mortality rate, you should immediately, but calmly, bring the child to the OR.

What virus is the most common cause of Croup?
 Parainfluenza
 

MC Question:

Clothesline injuries, though rare, classically cause these types of injuries?
A) Cricotracheal separation 
B) Thyrocricoid seperation 
C) RLN injuries 
D) Vagal nerve injuries 
D) A and C 
E) B and D 
F) All of the above

Free Response Questions:

Name at least three benefits tracheotomy has over intubation for prolonged airway management.

Quick Facts:
Intubation Injuries
-Complications include:
-scarring of laryngeal structures
-subglottic/tracheal stenosis
-granulation tissue formation
-vocal fold paralysis/paresis
-4-19% complication rate after prolonged intubation.
-Consider convert to trach after 5-7 days, benefits include:
-decreased dead space
-improve pulmonary toilet
-increase comfort, decreased sedation
-easier weaning
-decreased long term complications
-Risk factors include:
-large diameter ETT
-excessive patient movement
-repeated self extubations
-overinflated ETT cuff
-prolonged intubation.