Epiglottitis

Question 1

What is epiglottitis?

Answer 1

It refers to inflammation and swelling of the epiglottis

Question 2

What is the pathophysiological cause of epiglottitis?

Answer 2

It is secondary to infection - haemophilus influenza type B

Question 3

What is the pathophysiological consequence of epiglottis - deeming it as an emergency paediatric condition?

Answer 3

The epiglottis can swell and completely occlude the airway

Question 4

Epiglottitis is deemed as a rare paediatric condition. Why?

Answer 4

This is due to the introduction of the vaccination programme, in which all children are now vaccinated against haemophilus

Question 5

In which patients are at high risk of epiglottitis?

Answer 5

Unvaccinated children

Question 6

What are the seven clinical features of epiglottitis?

Answer 6

High Fever

Generally Unwell

Stridor

Muffled Voice

Saliva Drooling

Swallowing Difficulties

Tripod Position

Question 7

What is stridor?

Answer 7

It refers to a high pitched inspiratory noise caused by obstruction of the upper airway

Question 8

What is the tripod position?

Answer 8

It is when patients sit forward, lean forward and extend their neck

They usually have a hand on each knee

Question 9

What condition does epiglottitis present similarly to?How do we differentiate between these conditions?

Answer 9

Croup

In epiglottitis, the presentation is generally more rapid than croup

Question 10

What investigation can be conducted to diagnose epiglottitis?

Answer 10

Neck x-ray

Question 11

What is a feature of epiglottitis on x-ray?

Answer 11

Thumb sign

Question 12

What is a thumb sign? What x-ray view demonstrates this sign?

Answer 12

It appears as a soft tissue thumb shadow pressed into the trachea

Lateral View

Question 13

When should patients NOT be investigated or examined? Why? In these cases, how should diagnosis be conduced instead?

Answer 13

In all cases of suspected epiglottitis

This is due to the risk of acute airway obstruction

The diagnosis is made by direct visualisation, however this should only be done by a senior member of staff with the capability to intubate, if necessary

Question 14

How do we initially manage epiglottitis? Why is this important?

Answer 14

We don’t distress the child, instead we leave the patient alone and in their comfort zone

Instead we alert the most senior paediatrician and anaesthetist available

This is due to the fact that distressing the child could prompt airway closure

Question 14

What are the two supportive management options for epiglottitis?

Answer 14

Airway support

Oxygen

Question 15

What does airway support of epiglottitis patients usually involve?

Answer 15

It does not usually require intubation, however there is an ongoing risk of sudden upper airway obstruction, and therefore preparations need to be made to perform intubation at any time

Intubation is often difficult and needs to be performed in a controlled environment with facilities available to do a tracheostomy if the airway completely closes

Question 16

What are the two pharmacological management options for epiglottitis?

Answer 16

IV Antibiotics

Steroids

Question 17

What IV antibiotic is used to manage epiglottitis?

Answer 17

Ceftriaxone

Question 18

What steroid is used to manage epiglottitis?

Answer 18

Dexamethasone

Question 19

When do we administer pharmacological management options in epiglottitis?

Answer 19

Once the airway has been secured

Question 20

What is a complication of epiglottitis?

Answer 20

Epiglottitis abscess

Question 21

What is an epiglottitis abscess?

Answer 21

It is defined as a collection of pus around the epiglottis

This also threatens the airway, making it a life threatening emergency

Question 22

How do we manage epiglottitis abscesses?

Answer 22

We manage it in a similar way to epiglottitis