Vaishali Waindeskar

By Vaishali Waindeskar, Pooja Thaware, Garima Chamania, Anuj Jain and Ashutosh Kaushal

Laryngomalacia is the most common cause of stridor in neonates and infants. In laryngomalacia, there is a supraglottic collapse of the larynx during inspiration leading to obstruction and thus resulting in stridor. The exact etiology of laryngomalacia is still unknown. The neurological basis is one of the leading theories explaining the etiology. Laryngomalacia in most of the patients resolves with conservative management by two years of age. In severe cases of laryngomalacia or when symptoms are persistent beyond two years of age, such cases need surgical management in the form of supraglottoplasty. Flexible fibreoptic laryngoscopy is the gold standard for the diagnosis of laryngomalacia. Various classifications have been proposed to classify laryngomalacia, although considering dynamic airway changes might be the most acceptable basis for classification. Supraglottoplasty has higher success and a low complication rate.

Part of the book: Updates on Laryngology

By Sri Rama Ananta Nagabhushanam Padala, Vaishali Waindeskar, Ved Prakash Maurya, Rakesh Mishra and Amit Agrawal

Spinal shock is a clinical manifestation following injury to the spinal cord resulting from multiple mechanisms. It is a complex phenomenon with flaccid paralysis, absent anal wink, and bulbocavernosus reflex. Management strategy for such patients includes rapid evaluation and treatment strategies to minimize the impact of secondary spinal cord injury. The advanced trauma life support (ATLS) guidelines provide the basis for rapid assessment and stabilization of A (Airway), B (Breathing), and C (Circulation) before dealing with the neurological deficits under the primary survey. The emergence of better radiological investigations has been pivotal in categorizing spinal syndromes and reaching a precise diagnosis. Early initiation of treatment measures results in better neurological and functional recovery with minimal residual deficits. The role of steroids in spinal shock has been a highly debated topic, and the timing of surgery is variable, intending to eliminate the secondary injury. Clinical differentiation between neurogenic and hypovolemic shock is vital, enhancing the quality of care with realistic outcome expectations.

Part of the book: Management of Shock