Acute Epiglottitis

Question 1

Clinical

Answer 1

Acute inflammation of the epiglottis cellulitis of supra-glottic tissue 
Drooling baby, inspiratory stridor, feverish, short of coughing
Tripod position: leaning forward 
High fever! 40 + 
RR: 30
HR increased
Inspiratory stridor 
Intercostal retraction 
Potato voice 

Symptoms:
Early - fever and sore throat
Late - dysphagia (difficulty) + odanophagia (painful) =
Drooling - cannot swallow
NO COUGH
Clinical TRIAD: respiratory distress, dysphagia and drooling

Question 2

Epidemiology

Answer 2

2-7 years of age

Question 3

Etiology

Answer 3

In child: bacterial infection - H. Influenza
Non immunized children because there is a vaccine
Will secrete: LPS endotoxin (gram -)

Adults: group A strep - tonsils -> acute rheumatic fever

Question 4

Complication

Answer 4

Acute obstruction of airway = asphyxiation

Question 5

Dx

Answer 5

Clinically (mainly) –> then intubate
DO NOT PERFORM A PHYSICAL EXAM
- waste time in the ER
- you might close the airway

Thumprint sign on a X-ray

Question 6

Tx

Answer 6

ABC
A: maintain airway
Intubation - supraglottic swelling and the erythema makes it hard to identify the airway
Tracheostomy

AB: Ceftriaxone - 3rd cefalosporin gram -
Steroid antiinflammatory
Humidified air
O2 and IV fluids

Question 7

Stridor vs wheezing

Answer 7

Stridor: Upper respiratory airway obstruction (inspiratory)
Wheezing: lower respiratory tract (expiratory)