Epiglottitis Flashcards
What is Epiglottitis?
Inflammation and swelling of the epiglottis, caused by infection (typically Haemophilus influenza Type B).
Why is Epiglottitis a life-threatening emergency?
The epiglottis can swell to the point of completely obscuring the airway within hours of symptoms developing.
EPIGLOTTITIS vs. Croup (3).
- Sudden onset (vs. over a few days).
- Continuous Soft/Snoring Stridor (vs. more obvious when upset and harsher).
- Secretions drool out (vs. infant swallows oral secretions).
Differential Diagnoses of Stridor (4).
- Acute Epiglottitis.
- Croup.
- Inhaled Foreign Body.
- Laryngomalacia (congenital abnormality, presenting at 4 weeks of age).
Stereotypical Patient (3).
- Unvaccinated child.
- Features : Fever, Sore Throat, Difficulty Swallowing.
- Presentation : Sitting Forward in Tripod Position and Drooling.
What is the Tripod Position?
A hand on each knee; it makes it easier to breathe if leaning forward and extending neck in a seated position.
Why should investigations not be performed if epiglottitis is suspected?
Risk of acute airway obstruction.
Diagnosis of Epiglottitis.
Direct visualisation only done by senior staff who are able to intubate.
Radiology of Epiglottitis.
Lateral X-Ray of Neck : ‘Thumb’/’Thumbprint’ Sign.
This is a soft tissue shadow that looks like a thumb pressed into the trachea (caused by oedematous and swollen epiglottis. This is also useful in excluding a foreign body.
Management of Epiglottitis (5).
- DO NOT DISTRESS PATIENT (prompts closure of airway) so leave in comfort zone.
- Alert the most senior paediatrician and anaesthetist.
- Make preparations to intubate (though most patients don’t require it) e.g. tracheostomy and ITU transfer.
- IV 3rd Gen Cephalosporin Antibiotics e.g. Ceftriaxone and Steroids e.g. Dexamethasone once airway is secure.
- Notifiable Disease.
Complication of Epiglottitis.
Epiglottic Abscess - also threatens the airway (another life-threatening emergency). Management is similar to Epiglottitis.
Epidemiology of Epiglottitis.
- 95% reduction in incidence since HiB Vaccine was introduced in 1992 so now rare.
- Affects kids between 2 and 7.
Pathophysiology of Epiglottitis.
Bacterial infiltration of epiglottis and surrounding supraglottic structures leads to supraglottic inflammation and oedema to cause narrowing of the airway and airway obstruction.