LIBRO + ANEXOS NEUMOLOGÍA PEDIÁTRICA

Neumología Pediátrica. Anexos ❚ 109 1. Know that because the cricoid cartilage is a complete ring, edema of airway wall in this region causes a greater reduction in airway lumen than in areas in which cartilage rings are incomplete 4. Diagnosis and clinical manifestations a. History 1. Know that a history of recurrent croup suggests an underlying anatomic airway abnormality, gastroesophageal reflux, or atopy b. Physical examination 1. Recognize the effects of agitation on ventilation in infants with croup c. Imaging 1. Recognize the radiographic appearance of croup 2. Recognize the lack of correlation between radiographic findings and the severity of the obstruction in acute laryngotracheobronchitis d. Pulmonary function tests e. Other investigations f. Diagnostic criteria g. Complications 1. Know that hypoxemia and carbon dioxide retention in a child with croup are suggestive of severe upper airway obstruction or the development of lower airway or parenchymal disease 5. Prevention and therapeutic approach a. Prevention b. Therapeutic approach 1. Know that epinephrine by inhalation provides symptomatic relief of airway obstruction in viral croup, that its effects are transient, and that it does not affect the duration of the illness 2. Understand the principles of helium/oxygen therapy in children with severe upper airway obstruction secondary to viral croup (ie, turbulent flow through large airway is density dependent) 3. Know that endotracheal intubation using an endotracheal tube one size smaller than predicted tube size (based on age and weight) is the preferred method of establishing an artificial airway in patients with viral croup 4. Recognize the indications for placing an artificial airway in a child with viral croup (eg, increased frequency of treatment with epinephrine by inhalation, hypoxemia, apparent or impending carbon dioxide retention, and fatigue) 5. Know that in acute laryngotracheobronchitis, airway obstruction may recur within one to two hours after therapy with epinephrine by inhalation, but is unlikely to recur if the patient does well for 4 hours after racemic epinephrine c. Side effects of therapy 1. Know that subglottic stenosis is a complication of intubation in patients with laryngotracheobronchitis 2. Recognize the indications for tracheostomy in patients with viral croup 6. Prognosis