Acute Epiglottitis

Question 1

Acute Epiglottitis

Answer 1

Infectious inflammation of the epiglottis posing risk of airway compromise
- More likely in children not immunised against HiB

Clinical picture
- Abrupt onset
- Respiratory distress
- Absent cough with low-pitched stridor
- Muffled / hoarse voice
- Tripod posture / sniffing positions
- Drooling
- Fever

Differential
- Croup
- Peritonsillar Abscess
- Bacterial Tracheitis
- Airway foreign body
- EBV

Non-pharmacological management pre-hospital
- Calm and comfort child / keep child with mother
- NBM
- Oxygen to maintain saturations above 92%
- Ambulance transfer to hospital
- Do not conduct throat examination.

Urgent transfer to tertiary hospital via ambulance for airway management and IV antibiotics

• Ceftriaxone 50mg/kg (Max 1g) IV Once Daily
  
  • Alternative - Cefotaxime 50mg/kg (Max 1g) IV 8-Hourly
  • Immediate non-severe or delayed severe penicillin allergy?
    
    • Moxifloxacin 10mg/kg (Max 400mg) IV OD

Controversial but Common Practice, use IV Dexamethasone to reduce airway inflammation
- Dexamethasone 0.15mg/kg (Max 10mg) IV Single dose. Can repeat if indicated in 24 hours

Downtitration to Per oral for total duration of treatment 7-10 days