Epiglottis

Question 1

How does epiglottitis present?

What age does it commonly present in?

Answer 1

• Very acute onset
• High fever in an ill, toxic-looking child
• An intensely painful throat
• Difficulty speaking & swallowing, salvia drools down chin
• Soft Inspiratory stridor
• Rapidly increasing respiratory distress (hours)
• Unlike croup a cough is not common
• Occurs most commonly in children aged 1 - 6years old but can occur at any age.

This is an emergency

Question 2

What is the pathophysiology of epiglottitis?

What pathogen?

Answer 2

• It is a life threatening URTI which can cause total upper airway obstruction.
• It is caused by H.influenzae type B (HIB) - a bacteria but due to vaccination against HIB it is now very rare.
• It causes severe swelling of the epiglottis and surrounding tissue associated with septicaemia.

Question 3

How do you manage epiglottitis?

Answer 3

• Urgent hospital admission and treatment are required.
• Do not do any investigations, as you want the child to remain calm, if they get upset they might fully obstruct there airway.
• Paige a consultant ENT surgeon and Anaesthetist with experience in paediatric care.
• The anaesthetist will intubate the child and the abx therapy will be commenced.
• The ENT surgeon will be there in case the patient cannot be intubated and needs an emergency tracheostomy.

Prophylaxis with rifampicin is offered to close household contacts

Question 4

What are other airway obstructions you need to be able to differientate from?

Answer 4

• Viral croup
• foreign bodies
• Smoke inhalation
• Bacterial tracheitis