EPIGLOTTITIS Flashcards
History & Physical
Ask about:
Abrupt onset high fever, sore throat, drooling
Rapid progression stridor and respiratory distress
Neck pain
Voice Change
Pain with gentle palpation of hyoid bone
Fever (83%)
Stridor (83%)
Sore Throat (67%)
Dysphagia (67%)
Drooling (67%)
Dyspnea (50%)
Odynophagia (17%)
Dysphonia (17%)
Investigations
Lateral xray soft tissue neck in extension and during inspiration if uncertain
Thumbprint signs
Blood Cultures
Epiplottis cultures (less sensitive)
Management
Monitor
Oxygen
Vitals
IV Access
Equipment: Airway
AIRWAY
Rapid Bedside Assessment:
Drooling
Voice change
Stridor
Inability to speak
Tripod or sniffing positioning
Hypoxia
Swelling of the posterior oropharynx
Inability or unwillingness to lie flat
Position upright, head tilt / chin lift
Secure Airway in patients with impending airway obstruction
Awake / Nasal Intubation if Limited oral access
Fiberoptic Visualization > Video Laryngoscopy > Direct
Prepare for surgical airway PRIOR to non-surgical airway
Alert ENT or anesthestiology for emergent airway management
Racemic Epi (2.25%), 0.05 mL / kg / dose up to 0.5 mL
OR
L-epinoephrine (1:1000) 0.5 ml / kg / dose up to 5 mL
Dexamethasone 0.6 mg / kg IV
OR
Methylprednisone 2 mg / kg IV
Combination antibiotic therapy including 3rd generation cephalosporin and methicillin-resistant Staph Aureus Coverage
Cefotaxime 50 mg/kg IV q 8 hr (maximum dose 2 g)
OR
Ceftriaxone 50 mg/kg IV q 24 hours (max dose 1 g)
Plus
Vancomycin 10 mg / kg / dose IV 60-80 mg/kg per day IV divided every 6-8 hours (maximum dose 2 g).
CIRCULATION
20 ml / kg crystalloid IV bolus
DDx
Angioedema
Bacterial Tracheitis
Diphtheria
Epiglottitis
Lemierre Syndrome
Ludwig Angina
Mononucleiosis
Peritonsillar Abscess
Retropharyngeal Abscess
Uvulitis
