Epiglotitis Flashcards

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1
Q

Define

A

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

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2
Q

Symptoms and Signs

A

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”
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3
Q

Investigations and Management

A

MEDICAL EMERGENCY - ITU

  1. Do not lie the child down (their immobile and upright stance is optimal)
  2. Do not examine the child’s throat (may precipitate total obstruction)
  3. 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’
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