Paediatric: Epiglottitis

Question 1

What is Epiglottis?

Answer 1

Epiglottitis is inflammation and swelling of the epiglottis caused by infection, typically with haemophilus influenza type B.

Question 2

Why is it a life threatening emergency?

Answer 2

The epiglottis can swell to the point of completely obscuring the airway within hours of symptoms developing. Therefore, epiglottitis is a life threatening emergency.

Question 3

Symptoms

Answer 3

Patient presenting with a sore throat and stridor
Drooling
Tripod position, sat forward with a hand on each knee
High fever
Difficulty or painful swallowing
Muffled voice
Scared and quiet child
Septic and unwell appearance

Question 4

Investigations

Answer 4

Performing a lateral xray of the neck shows a characteristic “thumb sign” or “thumbprint sign”.

Question 5

Management

Answer 5

Epiglottitis is an emergency and there is an immediate risk of the airway closing.

If you see a child with suspected epiglottitis, leave them well alone and in their comfort zone. Don’t examine them and don’t make them upset. The most important thing is to alert the most senior paediatrician and anaesthetist available.

Question 6

Treatment once the airway is secure

Answer 6

IV antibiotics (e.g. ceftriaxone)
Steroids (i.e. dexamethasone)

Question 7

Prognosis

Answer 7

Most children recover without requiring intubation. Most patients that are intubated can be extubated after a few days and also make a full recovery. Death can occur in severe cases or if it is not diagnosed and managed in time.

Question 8

Common complication

Answer 8

A common complication to be aware of is the development of an epiglottic abscess, which is a collection of pus around the epiglottis. This also threatens the airway, making it a life threatening emergency. Treatment is similar to epiglottitis.