Dr Adam Thomas reminds us in the podcast (8:30 – 12:50) that when you encounter a patient with stridor the most important thing is to THINK THE WORST FIRST:
We’re going to emphasize the differential diagnosis. Think the worst first with all upper airway obstructions.
- foreign body aspiration
- tracheal stenosis
- bilateral vocal cord paralysis
- a CNS or neurologic catastrophe causing vocal cord dysfunction
- rapidly progressive airway obstruction
- go looking for the neck hematoma or neck infection.
[Dr Farkas states that if the patient isn’t crashing and you have access to a nasopharyngoscope, it can be a great tool for diagnosis. And it should be in an emergency physician’s skill set.]
[Another test Dr Farkas recommends (again only if the patient is stable) is a CT scan of the neck and chest. It can rule out a lot of anatomical bad stuff (above).]
In this post I link to IBCC chapter & cast – Vocal cord dysfunction
June 22, 2020 by Dr Josh Farkas:
Vocal cord dysfunction is a masquerader of life-threatening pathologies (most notably asthma and anatomic upper airway obstruction). Vocal cord dysfunction itself is not dangerous, but if not properly diagnosed it may lead to considerable iatrogenic harm (e.g. multiple unnecessary intubations for “asthma”). On the flip side, incorrect diagnosis of vocal cord dysfunction is also dangerous, as this could lead to inadequate treatment of a true airway emergency.
Here is the link to the podcast.
Here is the link to the show notes.