Laryngeal edema acute care
The most complex sections of pediatric surgery,pediatrics and otolaryngology are the sections that deal with the treatment of children with laryngeal obstruction. There are many reasons for such violations. It can be congenital malformations, as well as acquired stenosis of the larynx. Let's try to understand what this pathology is.
Stenosis of the larynx in children is the narrowing of its lumen, which leads to a difficult passage of air in the process of breathing.
Acute and chronic stenosis of the larynx
Stenosis of the larynx according to the nature of the development of pathology is divided into acute and chronic.
Acute stenosis of the larynx is a condition whenwhich narrowing occurs in a short period of time, and leads to the development of general hypoxia. This pathology is most common in young children because of the anatomical structure of their larynx. At this age, the entrance to the larynx is covered with an overhanging soft epiglottis, its lumen is narrow enough, and in the subglottic department a loose connective tissue is developed, which is very prone to edema.
Chronic laryngeal stenosis develops slowly andis stable. Up to a certain point, the body more or less copes with the decrease in air intake in the case when the narrowing of the laryngeal lumen develops slowly and gradually.
However, if there is a rapid development of symptoms, immediate action is required.
The most common causes of acute stenosis areinflammatory diseases of the larynx, as well as ingress of foreign bodies, traumas of a different nature, allergic edema and tumor processes, cicatricial narrowing of the larynx, development of an infectious granuloma, papillomatosis of the larynx and violation of its innervation.
Often the cause of stenosis in children are infectious diseases (influenza, scarlet fever, measles, tuberculosis, syphilis, etc.).
It should be noted that the entire process of disease development is conditionally divided into 4 stages.
- Compensation stage. During this period, there is a pause between exhalation and inspiration, the sigh lengthens, its shrinking occurs, the number of breaths decreases reflexively. The child's voice becomes hoarse, with a characteristic stenotic noise on the breath, which is heard even at a considerable distance. Bradycardia is noted (decrease in heart rate).
- The stage of decompensation. In this period there are clearly signs of hypoxia, dyspnea increases, in the process of inspiration there is a retraction of intercostal spaces, jugular, supraclavicular and subclavian pits. Mucous membranes and skin become cyanotic. The child is showing anxiety, becomes covered with cold sweat, breathing becomes more frequent and stenotic noise is intensified.
- The stage of decompensation. The patient takes a forced position (half-sitting with his head thrown back). When inhaling, the larynx produces maximum movement downward and with exhalation - up. Breath noisy, face pale-cyanotic color, cyanosis of the lips, fingertips and nose. Pulse is frequent, filling falls.
- Stage of suffocation (asphyxia). There is a drop in cardiac activity, there is a rare, superficial and intermittent breathing (by the type of Chain-Stokes), the skin covers acquire a pale gray shade, the pupils dilate. At this stage, the child becomes listless and indifferent, there is a loss of consciousness, there comes a stop of breathing, exophthalmos (bulging eyes), involuntary urination and fecal matter departure. Pulse is threadlike, cardiac activity is falling, after which a fatal outcome occurs.
It should be noted that to assess the degreeStenosis is a very significant amount of clearance of the glottis. Also, for correct diagnosis, it is necessary to exclude respiratory disorders due to cardiopulmonary pathologies and stenosis of the trachea.
- First of all, the child must be placed in a semi-sitting position.
- To make a set of distractions(warming compresses on the neck and chest area), warm foot baths and warm alkaline drink (bicarbonate mineral water or milk mixed with such water).
- A catheter or an electric pump to restore respiratory patency.
- Humidified oxygen is recommended in this state.
- On the recommendation of the doctor, Relanium, Seduxen or sodium oxybutyrate solution is administered intravenously.
- It is also necessary to administer prednisalone, hydrocortisone, euphyllin, heparin, sodium hydrogen carbonate and strophanthin or corglicon.
- According to the indications, in case of exposure to an infectious agent, antibiotics of a wide spectrum of action are prescribed.
Emergency care for stenosis of the larynx in children
In the case when the development of acute stenosis of the larynx, the child's measures are insufficient, urgent tracheostomy is necessary (opening of the lumen of the trachea).
If the process is at the stage of asphyxia, first conyotomy (median dissection of the larynx) and then a tracheotomy.
When a tracheotomy is performed, the trachea is opened andThe introduction into its lumen of a special tube to create access to the respiratory tract of the outside air. This is an emergency procedure that is used to save a patient's life.