Epiglottitis Flashcards
What is epiglottitis?
Epiglottitis is acute inflammation of the epiglottis, which can rapidly progress to severe airway obstruction, usually associated with significant systemic illness.
anatomically, where is the epiglottis?
The epiglottis is a cartilaginous flap located in the larynx
What is the epiglottitis’’ function?
Its function is to close over the opening to the airway (glottis) during swallowing. This prevents food or liquids from passing into the trachea and the lungs.
What can inflammation of the epiglottis lead to?
Airway obstruction
What is the most common cause of epiglottitis?
Infection
What pathogen is the most common cause for epiglottitis?
Haemophilus influenzae type b (Hib)
What has reduce the incidence of epiglottitis?
Hib Vaccine
What other organisms can cause epiglottitis?
streptococcus pneumoniae, group A streptococci and staphylococcus aureus
Can virus’ cause epiglottitis?
Yes but is rare
What are 3 examples of viral causes of epiglottitis?
- Herpes simplex virus
- Infectious mononucleosis
- Fungal infections like candida
What are some non-infectious causes?
- Thermal injuries
- Chemical burns
- Foreign body ingestion
What are 4 risk factors for epiglottitis?
- Individuals without the Hib vaccine
- Immunocompromised patients
- Men in mid-40s
Additional co-morbidities
What are typical symptoms of epiglottitis?
Severe and acute onset of sore throat
Muffled voice
Drooling
Inspiratory stridor
Difficulty swallowing (dysphagia) and/or painful swallowing (odynophagia)
What do most patients also report alongside epiglottitis?
A recent upper respiratory tract infection (URTI)
Do adults or children often present with a slower less severe set of symptoms?
Adults
During clinical examination, why should no action be taken to stimulate or irritate the patient?
Because it may trigger a laryngospasm in an already critical airway.
What can the symptom of a muffled voice often be referred to as?
Hot potato voice
What position is common amongst patients with epiglottitis?
Tripod position: sitting up on hands, with the mouth open and head forward to increase airflow (commonly seen in children)
What other clinical findings are typically present?
Drooling (more common in children)
Signs of respiratory distress: dyspnoea, tachypnoea, use of accessory muscles and cyanosis are severe findings and indicate impending respiratory failure (seen in both children and adults)
Inspiratory stridor: can sometimes be a late finding and indicates advanced upper airway obstruction.
Hypoxia
Tachycardia
Fever
What are some differential diagnoses’ of a sore throat?
- Acute tonsilitis
- Acute pharyngitis
- Peri-tonsillar abscess (Quinsy)
- Deep neck space infection
What are some differential diagnoses’ of stridor?
- Laryngotracheobronchitis (Croup)
- Foreign body inhalation
- Anaphylaxis
- Laryngitis
Why are investigations in the immediate period avoided unless the patient is stable?
The condition is time critical
What are the investigations if there is a strong clinical suspicion of epiglottitis in an unstable patient?
they will likely be taken to a controlled environment, such as the operating theatre, for examination of the airway plus endotracheal intubation or a surgical airway.
Once the airway is secure, what other further laboratory investigations can be carried out?
- Blood tests
- Blood cultures
- Culture swab from epiglottis
What are the first-line investigations in a stable patient?
direct flexible (or rigid) laryngoscopy to visualise the airway.
Normally performed by ENT, this confirms swelling and inflammation of the epiglottis and inflammation of surrounding supraglottic structures.
What is used to secure the airway during investigations?
endotracheal intubation or an emergency surgical airway (i.e. tracheostomy)
What is the second-line imaging for epiglottitis?
lateral neck radiograph
What is referred to as the ‘thumbprint sign’ found on a lateral neck radiograph?
severely swollen epiglottis
What is the main priority in management of epiglottitis?
The main priority is to secure the airway in a controlled environment, as patients (particularly children) can deteriorate quickly.
What is the treatment of epiglottitis?
they will be managed in critical care with monitoring, IV antibiotics and subsequent extubation in a controlled setting.
What does additional management include?
- Nebulised adrenaline
- High-flow oxygen
- Intravenous broad-spectrum antibiotics
- Corticosteroids
- Fluid replacement therapy
- Analgesia
What intravenous broad-spectrum antibiotics are used to treat epiglottitis?
a third-generation cephalosporin (e.g. ceftriaxone or cefuroxime) is often used
Why are corticosteroids used as treatment?
e.g., dexamethasone): usually given as a stat dose on acute presentation.
corticosteroids may help reduce supraglottic inflammation.
What are 3 complications of epiglottitis?
- Epiglottitis abscess
- Deep neck space infections
- Mediastinitis
Why is epiglottitis an emergency condition?
Epiglottitis represents a life-threatening condition which can quickly lead to severe airway obstruction with high mortality.
