Epiglotitis Flashcards
Define
Intense swelling of epiglottis associated with sepsis; most common ages 1-6yo (can affect all ages)
Cause = Haemophilus influenza type B (HiB) – QUITE UNCOMMON NOW DUE TO VACCINATION
So worried about in unvaccinated
Symptoms and Signs
MEDICAL EMERGENCY: N.B. no cough (like in croup)
- Very acute onset
- High fever (‘toxic-looking’ child)
- Intensely painful throat which stops child from speaking or swallowing
- Drooling (child cannot swallow as too sore)
- Stridor (soft inspiratory with high RR)
- Immobile, upright and open mouth “Tripod sign”
Investigations and Management
MEDICAL EMERGENCY - ITU
- Do not lie the child down (their immobile and upright stance is optimal)
- Do not examine the child’s throat (may precipitate total obstruction)
- Make sure child is well and settled, don’t do anything which might upset them
(1) Escalate to seniors - Immediate referral to ENT, paediatrics and anaesthetics -> transfer to ITU/anaesthetics à secure airway (endotracheal intubation) and give supplemental oxygen
(2) Blood cultures and empirical IV ABx (cefuroxime)± dexamethasone(reduce inflammation) given for 3-5 days
Most children recover in 2-3 days with app treatment
Rifampicin given to close household contacts as prophylaxis
However, x-rays may be done, particularly if there is concern about a foreign body:
- a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’
- in contrast, a posterior-anterior view in croup will show subglottic narrowing, commonly called the ‘steeple sign’