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Okay. Okay. Hello again. So I know you were gonna be able into Strider and Children, right? This is a brief chat on just keeping basics. Keep it Keeping it simple. Yes. So objective. Here it's defined straighter. And then talk about the common causes of management. Okay, So important thing to remember here, first of all, as straighter, is a symptom of a It's a harsh signed or could be high pitch, low pitch sound. But just remember, it's not a diagnosis. It is a symptom. Okay? And it's basically caused you to turbulent airflow in three. And your old airway. Okay, where can you develop straighter, So no nose and mouth. So think about a person snoring up in that area that signed in spirit resigned in the larynx area on where the voice box is on, then the trachea. So keep the sorts three areas really mean that you developed a signed here on it can be related to different features off breathing, so inspiration or expression. Why you to Children tend to develop strider more quickly than not als again. Children's airways are smaller, the nodules, So there's the diameter of their way. If it's breached for any reason, as in something within the trip as in a foreign body or within the walls. If there's inflammation or relation there or something overlying the chip, then there could be pressure on the chip on that. I could easily compress the airway, and we just the diameter increased airway resistance and make it more difficult with breathing. So Strider can happen a lot quicker and Children, because simply their airway is smaller. So, as I said there, it can happen during different phases of breathing. It was inspiration. It's above the voice box, generally X, very below the about the voice box. If it's in both visas of breathing, it's called by physic. Okay, and I will go on to the most common causes that we would see here in the Marshall Department. For Strider, there's a million calls a spots, ones that were we would most importantly, not want to miss would be Crip, a foreign body, and then more than the infections. So bacterial tracking anus. There's a lot of other infections, but I've been good at this one rather than a big potato is, for example, the cause of the introduction of the head vaccine, and we don't really see that as much anymore epiglottitis on. Then the more chronic, less less worrying causes off Strider would be things like, uh, during your malacia, which is a floppy Lawrence So crypt. Let's move it. Move onto Creek. When these Children walk through the door, they are classically everyone. Well, that's a sport diagnosis on. We all know what most people who have worked in the apartment. We'll know what their signs, like a barking say. I don't know if anyone wants to demonstrate that signed, but if you're not aware of it, can go look it up on the when you took Okay, so grip is a virus, usually preceded by a couple of days of Caries. Ultram symptoms generally occurs and Children from six months to six years of age. The commitment is barking, classical say, like golf. They could be horse on a say. It's like a inspiratory signed. They make crypt simply is inflammation in that upper airway off the child on the treatment is anti inflammtory on the inflammatories. Usually most Children who develop this virus, which is caused by parainfluenza 80% of cases that's usually once off. Yes, it can be occur. But most cases it's a once off, and it's a once off treatment world like semester. Still 0.15 makes per kilo. There's lots of research and evidence showing that there's a lot of controversy around the dosage, but generally speaking, 0.15 works on that works well on that usually requires no further repeated dose. If the China's vomiting or their chili on well and have a lot of respiratory distress, you might consider nebulize budesonide 2 mg that instead or moved to other things like if the child is very, very unwell. Nebulized adrenal on that would be used really as a holding measure because the child is the definitive airway on a knack, IUs child will be in resource in a calm and controlled environment. Anesthetics will be involved earned on the child a controlled airway from that perspective. But that's worst case scenario. I was on the extremes of years is most. Most of the race e here are see for discharge after trial off the dexamethasone, Okay, but they don't usually have any further problems during the line. Yeah, patiently. They come by 12 hours later on, they got repeated dose old dexamethasone rough like. But for the most part, no. It's a once off treatment for a once off viral illness on it's It's for the most part well managed on these totally go home. So does anyone know the name off the scoring system to determine how you severe child scriptures? Yes, that's correct. Wesley Scoring system on before I see before I move on to the next slide with the breakdown of the clinical features that you look for. Does anyone want to hazard gas of what they remember from the scoring system is what would classify as what would you be looking for in a child who who comes in with Crip to see their severe or moderate or mild in terms of their chest wall? Their breathing? Yes. Brilliant. So chance for traction is one of them. Yeah, Cyanosis. Yep. Lot of people on here will definitely know these and this information, But don't be shy. That says, for everybody to be involved in interact with GCS. You're staying on the show. Okay, I'll move on here. This light. Okay, So level of consciousness. If that will score your points if you if it's for just start to sort of destroyed tries disorder, big points, cyanosis, strider, strider at rest when agitated. A difference in scoring an airway as a normal air entry is normal. Decreased morbidity creased. Do they have any retractions on, if so, within my motors of year? So it this is a guide to help you decide. Does this tribe need further monitoring in the hospital or No, This child is well for home, and it's really good how this document it documentation means happened. Doc know documentations. It wasn't considered document document, doctor, but I can't emphasize that's an off. So moving onto another reason for straighter is foreign body inhalation. This is acutely serious. On generally, the clinical history gives you the insert. In 80% of cases, there's like your own set of a choking episode or a coughing episode on acute onset of this funny noise and get the parents too. Describe the noise. If you If the child doesn't make it at that time, Onda, generally they'll be something missing. Maybe there's a toy that's missing or a piece of something or leg a piece on Just the Way Our anatomy is me, it classically If there is an obstruction in the in the airways, it tends to be doing that right side of the chest on. Sometimes if you're going to all scaly it, you can hear unilateral reason on that site. And there was a 20 on the experiment film of a chest X ray. You'll see a dark right area on that site where the foreign body has dropped. So this is this requires urgent attention. Urgent inward referral to the ent uh, surgeons, I said. It's beautiful there, too, so something you don't want to miss. I know. Recently, there's been a lot off foreign bodies. Foreign bodies been being swallowed in the department of recent lots of lots of money in Children, coins and all sorts. But this does not going to affect their because it's in the esophagus. But this is a little Kia. So this is on that airway. So it's going to affect the signed that May here, and it's again. These are all potentially life threatening need actually okay of included bacterial track. Your rate is here as one of the bacterial infections that Children Condell a pin there upper airway unfold, moving all right into their into their bronchioles. Um, it's bacterial target is these Children, or generally they have a barking cough, and they're strangers, but they look a lot sicker. They're a lot more toxic than high temperatures, their purchasing mals of think presidents, monkey secretions they are. They are in high risk of obstructing their airway. So what they need. Sergent Lee is in a again in a nice, calm environment. Calm controlled environment in the resource area, with ent and anesthetics all getting involved in early doors on antibiotics administered. I'm not sure if this picture of projecting well we're clearly and off. But certainly if you like dying, just don't along the trachea. It's it's the lining of It's very irregular and sloth, and that would suggest that there is mucus present secretions instead of a nice, smooth trachea that you would normally normally see in these in Children. So second child needs herget attention quickly, and then I see if environment reason why I say come is because of these Children out set in any way, shape or form, their airway is could become revised all the quicker, so uneven for for themselves. For the parents. If you are looking like you're in control. Even if you're know, always feeling that way, it's Everyone can concentrate better. Okay, so last night I would talk here about a chronic straighter, I think called relation. It's quite common thing, and you born in that first year of life. Where is cartilage? It just hasn't fully formed. It's floppy. It's robbery. So an inspiration. There's. There's a slight collapse in the airway, and it can cause that inspiratory stridor e signed. Um, these Children are absolutely generally 100% otherwise feeding well and thriving away. But if there is any any query, usually after the age of one years of age, still on going on there and there's some other concerning catcher referring the morning to the ENT team to follow up on, they made me go for, uh, laryngoscopy your bronchoscopy, a scoping of some nature. But generally it's nothing really to be worried about the floppy Lawrence on. It's a funny signed that they make, but they're okay, actually, Do you have a sudden this signed on a little person that I know quite well, Um, if you give them see this works, it's like to hear a few minutes I'm here to through this Inspiratory Strider signed, You know, again. Oh. Oh. So Okay, so that scared him on. This is it. This's my somebody being beside this. Like your photo. Shame. Yeah. So it's It's quite condition, but absolute non. Tori, about China's driving away on. Always good. So there you go. So that's also we've covered, um, causes a straighter what straighter is how high anatomically it it is created on. We have discussed some of the common things that come three any, but we don't want to miss, uh, any questions?