Stenosing laryngitis

Stenosing laryngitis (croup syndrome) is an acute inflammatory process in the larynx, often exciting trachea and bronchi. It is observed, as a rule, in the initial period of ARVI as a manifestation of the disease itself, but it can also be the result of the attachment of a bacterial factor, and then stenosing laryngitis is considered as a complication of acute respiratory viral infection. Especially often it occurs in children with allergic diathesis and is more severe at an early age, often with a wavy course. Inflammation and edema of the mucosa with a relatively narrow laryngeal lumen in children and cause breathing difficulties, amplified reflex spasm.

Clinical picture. Stenosing laryngitis occurs often sharply, mainly at night. In some children, it is preceded by symptoms of laryngitis (dry, especially barking cough, swelling in the throat, slight hoarseness of the voice). The severity of stenosing laryngitis is determined by the degree of stenosis and respiratory failure.

There are four degrees of stenosis. Stage I stenosis - short-term breathing difficulty or longer, but mild; Fits of difficulty breathing occur rarely, breathing noisy, hoarse voice, barking cough, small cyanosis, slightly pronounced traction of supple places of the chest, mainly in epigastrium. Respiratory failure is absent. Stenosis of II degree is characterized by duration (up to 5 days), violation of the general condition of the child, which becomes restless, barking, rough coughing intensifies, often attacks of shortness of breath, accompanied by retraction of all pliable places of the chest; Breathing is noisy, audible from a distance. Stenosis can be permanent or have a wavy appearance. Moderate respiratory failure. A sharp deterioration in the general condition is characteristic, marked paleness, cyanosis of the lips and limbs are noted. Stenosis of the third degree is a significant and persistent difficulty in breathing with retraction of all pliable places of the chest (jugular fossa, supra- and subclavian spaces, epigastric region). Sweating, severe anxiety of the child (the patient rushes in bed), breathing in the lungs is weakened. There are signs of cardiovascular failure (loss of pulse wave, etc.), signs of increasing hypoxemia - pallor, adynamia. Respiratory failure is pronounced. Stenosis of the fourth degree - asphyxia stage.

The diagnosis is based on the history and clinical picture.

Differential diagnosis is carried out with a foreign body, respiratory allergies.

Treatment is determined by the degree of severity of stenosis, its duration, as well as the presence of toxicosis caused by ARVI, the age of the child, its premorbid status.

When stenosis of 1 degree is necessary: ​​wide air access; Distracting therapy - mustard plasters for caviar and circular hot baths at water temperature up to 38-39 gr. C, abundant frequent warm drink (tea, borzhom, milk with soda), steam alkaline inhalation (4% sodium hydrogen carbonate solution with vitamin A, euphyllinum, hydrocortisone); Antispastic therapy (atropine, papaverine, luminal inside at age doses); Sedative (1-2% solution of sodium bromide in 1 tea, dessert, a tablespoon 3 times a day depending on the age) and hyposensitizing agents (diphenhydramine, pipolfen, etc.), vitamins. In the absence of effect - intranasal novocaine blockade, which helps to reduce the edema of the mucous membrane of the larynx and the removal of reflex spasm. Already at this stage of stenosis, especially in the presence of fever, it is recommended to prescribe antibiotics. It is advisable to put the child in a room where the air is moistened with steam.

With stenosis of II degree, in addition to the aforementioned agents, humidified oxygen is widely used; With the aim of reducing edema of the mucous membrane of the respiratory tract - hypertensive I / O solutions (20-30 ml of 20% glucose solution, 5-10 ml of 10% calcium gluconate solution); Hormonal preparations: hydrocortisone-5 mg / kg, prednisolone - 1-1.5 mg / (kg-day); Cardiac agents (strophanthin or korglikon iv or digoxin orally), diuretics; Ney-roleptiki (aminazine, promazin, etc.), but carefully, so as not to suppress the cough reflex and not miss the moment for surgical treatment.

With stenosis of grade III, prednisolone IV (1.5-2 mg / kg), with the first dose being half daily; More widely used heart means; Broad-spectrum antibiotics (chains, tetraolean, etc.), as well as sodium oxybutyrate (GHB). In the absence of effect, therapeutic laryngoscopy is performed, during which polyethylene catheter is sucked off mucus, dry bloody crusts are removed, the mucosa is smeared with a solution of ephedrine, hydrocortisone, peach, apricot or vaseline oil. Sometimes direct laryngoscopy is repeated several times. With stenosis of III degree, also medical bronchoscopy (removal of mucus, pus, crust, flushing of bronchial tubes, intratraherononal administration of antibiotics) is also indicated, but there must be complete readiness for immediate tracheostomy.

If the above measures are ineffective, the severity of stenosis does not decrease, there is a tendency to progress of cardiovascular insufficiency (paradoxical pulsing of the pulse wave, adynamy, pallor of the skin against persistent cyanosis of the lips, extremities, etc.), intubation or Tracheostomy.

The prognosis for the third degree of stenosis and asphyxia is serious; At I - II degree and early treatment - favorable.

Prevention: prevention of ARI, especially in children with allergic diathesis. SUBFEBRILITETTE IN CHILDREN. Etiology and pathogenesis. Subfebrile in children - polyethiologic syndrome; It can be caused both by foci of chronic infection (chronic tonsillitis, adenoiditis, cholecystitis, pyelonephritis, carious teeth, etc.) and a number of chronic diseases (tuberculous intoxication, lymphogranulomatosis, drug allergy, tumors, rheumatism, etc.). A special place among the causes of the subfebrile state in children is occupied by thermoneurosis, characterized by a persistent heat exchange disorder as a result of a functional damage to the temperature center, as a result of craniocerebral trauma or vegetovascular dystonia. Such subfebrile condition occurs more often in children who have an anamnesis of unfavorable course of pregnancy and maternity, physical or mental trauma, general overstrain. Functional violations of thermoregulation in a number of cases can be hereditarily conditioned (2-3%); More often inherited predisposition to impaired thermoregulation or a special type of reaction of the autonomic nervous system. The hypothalamus is of particular importance. Often, the readiness for temperature disruption is available for children by non-specific stimuli (endocrine disorders, overstrain, transferred diseases, overheating, etc.).

Clinical picture. About subfebrile condition, you can speak if the temperature rises to 37.5 g. C lasts 2 weeks or more. Otherwise it is a subfebrile fever.

Diagnosis and differential diagnosis. In all cases of subfebrile condition, the child should be carefully examined (preferably in a hospital setting). At the same time, the combination of subfebrile with other manifestations of vegetative dystonia (fatigue, sleep, appetite, excessive sweating, headache, dizziness, lability of pulse and blood pressure, etc.) and / or the presence of signs of endogenous depression in the patient allows to establish itself in the functional nature of impaired Thermoregulation. In these cases, it is necessary to perform, in addition to a general clinical examination, echoencephalography, cardiointervalography, EEG, and blood pressure measurement. Thermoneurosis is also characterized by normalization of temperature during sleep and practically no difference between axillary and rectal temperatures (not more than 0.5 gr C).

Treatment in cases of chronic diseases is reduced to eliminating the main cause. With functional violations of thermoregulation, the main place in treatment should be the proper organization of classes and rest, easy sport, sufficient stay in the open air, psychotherapy, acupuncture, hydrotherapy, physiotherapy, sedative drugs.

Prognosis and prevention are determined by the cause of subfebrile.