Acute Epiglottitis

Question 1

Definition of acute epiglottitis. What is the peak age of incidence

Answer 1

Acute cellulitis of the supraglottis (leading to inflammatio of the epiglottis and supraepiglottis) that may cause airway compromise. An airway emergency in children. Most classically described in children aged 2-6 years

Question 2

Causes of acute epiglottitis

Answer 2

H. influenzae type B (HiB)- now quite uncommon due to HiB vaccination so more associated with Staph A and GAS

Question 3

Presentation of acute epiglottitis

Answer 3

A surgical emergency
* Sudden onset drooling, stridor, inability to swallow. Breathing will be ‘tentative and careful’ without marked increase in RR
* High fever (‘toxic’ looking child)- tachycardia and pyrexia
* Immobile, upright and open mouth- ‘tripod stance’
* Can distinguish from croup since the child will NOT have a hoarse voice and will NOT have a cough
* May not have had vaccination against HiB

Question 4

Investigations for acute epiglottitis

Answer 4

• DO NOT EXAMINE THE THROAT (avoid lateral x-ray and lying down the child) of anyone with suspected epiglottitis as this may precipitate closure of the airway. Do not lie child down
• Intubate First- to avoid shock causing obstruction of the airay
• Blood- High WCC, neutrophilia, high CRP, ABG

Question 5

Management of acute epiglottitis

Answer 5

• If acute epiglottitis is suspected, urgen hospital admission to ICU and treatment are required
• Secure the airway (usually requires intubation) and give supplemental oxygen
• Take a blood culute and start IV 2nd or 3rd generation cephalosporins (ceftriaxone) for 7-10 days
• In some patients, steroids (dex) and adrenaline may be used to reduce inflammation
• In severe cases, prolonged intubation may be necessary
• Once stable and extubated, give oral co-amoxiclav
• Rifampicin prophlaxis to close contacts
• With appropriate treatment most children recoverwithin 2-3 days