Stridor is a high pitched sound resulting from turbulent gas flow in the upper airway. It may be inspiratory, expiratory or present on both inspiration and expiration. It can be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. Stridor is indicative of a potential medical emergency and should always command attention. Wherever possible, attempts should be made to immediately establish the cause of the stridor (e.g., foreign body, vocal cordedema, tracheal compression by tumor, functional laryngeal dyskinesia, etc.) That examination requires visualization of the airway by a team of medical experts equipped to control the airway.
The first issue of clinical concern in the setting of stridor is whether or not tracheal intubation or tracheostomy is immediately necessary. Some patients will need immediate tracheal intubation. If intubation can be delayed for a period a number of other potential options can be considered, depending on the severity of the situation and other clinical details. These include:
Expectant management with full monitoring, oxygen by face mask, and positioning the head of the bed for optimum conditions (e.g., 45 - 90 degrees)
Use of nebulized racemic epinephrine (0.5 to 0.75 ml of 2.25% racemic epinephrine added to 2.5 to 3 ml of normal saline) in cases where airway edema may be the cause of the stridor. ( Nebulized Cocaine in a dose not exceeding 3 mg/kg may also be used, but not together with racemic epinephrine [because of the risk of ventricular arrhythmias].)
Use of dexamethasone (Decadron) 4-8 mg IV q 8 - 12 h in cases where airway edema may be the cause of the stridor; note that some time (in the range of hours) may be need for dexamethasone to work fully.
Use of inhaled Heliox (70% helium, 30% oxygen); the effect is almost instantaneous
Stridor has many different potential causes. It may occur as a result of: