Acute epiglottitis

Question 1

Epiglottitis is characterised by

Answer 1

• the sudden onset of a toxic febrile illness
• a soft voice
• lack of a harsh cough
• a preference to sit quietly (rather than lie down)
• a soft stridor
• a sonorous expiratory component.

It is now uncommon where Haemophilus influenzae immunisation is routine

• but can be caused by Strep. pneumoniae.

Question 2

Management

Answer 2

Do not examine the throat in the office.

Escort the child to hospital—almost all require nasotracheal intubation.

Keep the child calm—allow mother to nurse child.

If obstruction, gently bag and mask with 100% oxygen.

Question 3

Method of emergency cricothyroidotomy (last resort)

Answer 3

Lie the child across your knees with neck fully extended.

Insert a number 14 needle or angiocath through the cricothyroid membrane.

Always try to intubate once before resorting to cricothyroidotomy.

Question 4

Hospital treatment

Answer 4

Intubation:

• in theatre suck away profuse secretions
• perform nasotracheal intubation.

Antibiotics:

• cefotaxime 50 mg/kg IV (max. 2 g) 8 hrly

or

• ceftriaxone 50 mg/kg to max. 2 g/d IV as single daily dose

Continue therapy for 5 days.

Early transfer to oral therapy (e.g. amoxycillin/clavulanate)