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Ninja Nerds!

In this episode of the Ninja Nerd Podcast, Zach and Rob break down upper respiratory tract infections using a simple, case-based approach that always starts the same way: decide if the patient is unstable. We define instability as the presence of bedside red flags such as stridor, hypoxia, drooling, tripod positioning, muffled voice, trismus, severe neck swelling, or hemodynamic instability. If any are present, airway management takes priority and imaging waits. If the patient is stable, the next step is to localize the lesion to the nose and sinuses, the throat, or the larynx.

We then move through the most common upper respiratory presentations. The common cold is managed only with supportive care. Rhinosinusitis is classified as viral or bacterial based on time course: viral disease improves within 10 days, whereas bacterial disease persists or worsens after initial improvement and is treated with amoxicillin-clavulanate. Tonsillopharyngitis is approached with targeted testing for Group A streptococcus using rapid antigen testing, with culture follow-up in children and teens if negative, and appropriate antibiotic treatment to prevent complications. Epstein-Barr virus is considered an important alternative when fatigue and posterior cervical lymphadenopathy are prominent.

The episode then focuses on high-risk causes of stridor. Croup is identified by a barking cough and treated with dexamethasone, with racemic epinephrine added for more severe disease. Epiglottitis is characterized by the absence of cough and the presence of fever, drooling, tripod positioning, a muffled voice, and inspiratory stridor, with airway-first management and intravenous antibiotics and steroids.

We close by reviewing downstream complications, including acute otitis media following a viral illness and dangerous deep neck infections signaled by trismus, muffled voice, drooling, and neck pain, reinforcing the need for early airway assessment and timely imaging when indicated.

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