Epiglottitis Flashcards
Define epiglottitis.
Epiglottitis is a cellulitis of the supraglottis with the potential to cause airway compromise, and should be treated as a surgical emergency until the airway is examined and secured
What pathogen is the cause of epiglottitis?
Haemophilus influenzae type B
Other potential pathogens include: Streptococcus pneumonia, Staphylococcus aureus, and MRSA. Rarely Pasteurella multocida has been reported.
Other: viral, fungal, caustic or thermal injury.
Why is epiglottitis more common in adults than children in the UK?
Hib immunisation programme - it used to be more common in children
Describe the onset of epiglottitis.
Rapid onset (usually 24-48 hours) sore throat, dysphagia, drooling and difficulty in breathing
Adults have a slower onset
What are the characteristic signs of epiglottitis?
- ‘toxic’ appearance
- tripod positioning
- rapid onset fevers
- drooling
- stridor/difficulty breathing (NB: chest will be clear)
What proportion of children with epiglottitis require intubation?
Almost all children
About 10% of adults
Should you examine a child with epiglottitis?
No action should be taken that could stimulate a child with suspected epiglottitis, including examination of the oral cavity, starting intravenous lines, blood draws, or even separation from a parent.
Epiglottitis is a clinical diagnosis and laboratory or other interventions should not preclude or delay timely control of the airway if epiglottitis is suspected.
Similar caution is required in fulminant acute epiglottitis in adults.
What is the management of epiglottitis?
- Consult senior staff (ENT, anaesthetics, ED)
- Secure the airway - direct rigid laryngoscopy or nasotracheal intubation. Tracheotomy only done as a life-saving measure.
- Antibiotics - empirin includes ampicillin/sulbactam or vanc/ceftriaxone
- +/- Oxygen and steroids - not proved but often used
What investigations should you do for epiglottitis?
Epiglottitis is a clinical diagnosis and laboratory or other interventions should not preclude or delay timely control of the airway if epiglottitis is suspected.
What would a lateral neck radiograph show in epiglottitis?
Markedly enlarged epiglottis, referred to as a ‘thumbprint sign’.
Describe the relative age incidence of these conditions:
- pneumonia
- bronchiolitis
- viral croup
- epiglottitis
- URTI
What are the complications of epiglottitis?
If untreated: airway obstruction, death, necrotising fasciitis, aspiration, asphyxiation
Mediastinitis - retropharyngeal space infection causes tachycardia and chest pain; 50% mortality
Pneumonia
What is the prognosis with epiglottitis?
If appropriate and timely treatment - good chance of complete recovery
Untreated infection can cause airway obstruction and death
