Acute epiglottitis (1B)

Question 1

What is epiglottitis?

Answer 1

A rapidly progressive infection causing inflammation of the epiglottis (the flap that covers the trachea) and tissues around the epiglottis that may lead to abrupt blockage of the upper airway and death.

Question 2

What is the most common causative organism for acute epiglottitis?

Answer 2

haemophilus influenza B

Question 3

Who is at risk for acute epiglottitis?

Answer 3

Hib vaccine

Question 4

When is the HiB vaccine usually given?

Answer 4

Infants will usually get their first dose of Hib vaccine at 2 months of age and will usually complete the series at 12–15 months of age.

Question 5

When would you suspect acute epiglottitis?

Answer 5

• tripod position - sitting up, leaning forward and extending neck
• rapid onset of fever
• unable to swallow - patient may present with drooling
• withdrawn appearance and signs of respiratory distress such as intercostal recession
• stridor (high pitch whistle on inspiration)
• not eating/drinking

Question 6

How do you manage a patient with suspected acute epiglottitis?

Answer 6

SECURE AIRWAY

if suspected do NOT examine throat/do NOT use tongue depressor

immediate airway support via endotracheal intubation (senior management)

Question 7

How is a diagnosis of acute epiglottitis confirmed?

Answer 7

Direct visualisation by SENIOR/AIRWAY TRAINED STAFF

X-ray may be done to confirm diagnosis or rule out foreign body

Question 8

You are asked to review a 30-year-old man in the emergency department. He has come in with a twelve-hour history of shortness of breath, fever, and strange noises with his breathing. He had a sore throat for the past few days but it has worsened rapidly. He has no past medical history otherwise.

His observations are respiratory rate 30/min, pulse 120bpm, oxygen saturation 96%, temperature 39.0ºC, blood pressure 110/60mmHg. On inspection from the end of the bed, he is obviously short of breath, has a muffled voice, and is drooling into a bowl. You can hear a high pitched whistle on inspiration.

What is the most appropriate next step?
A) Call the on-call anaesthetist to assess the patient for intubation
B) Give an immediate dose of IV dexamethasone
C) Give him nebulised salbutamol
D) Organise an X ray of his neck
E) Perform flexible endoscopy to assess the larynx

Answer 8

A) Call the on-call anaesthetist to assess the patient for intubation

ABCDE - secure airway