Resp - Acute Epiglottitis

Question 1

Definition

Answer 1

Inflammation and localised oedema of the epiglottis which can result in potentially life-threatening airway obstruction
- Classically caused by bacterial infections - Haemophilus influenzae B

Question 2

Epidemiology

Answer 2

Peak incidence - 6-12 years
- since the introduction of the HiB vax - the incidence has shifted from children to adults
Male
Unvaccinated
Immunocompromised

Question 3

Signs

Answer 3

• Stridor
• Respiratory distress
  = intercostal + subcostal recession, tracheal tug, nasal flaring, accessory muscle use
• Pyrexial (~40deg)
• Tripod position - sign of respiratory distress = Px leaning forward and supports their upper body on their knees
• Looks very unwell over ‘toxic’

Question 4

Symptoms (RODDDD)

Answer 4

Rapid Onset within hours
Dysphagia
Dysphonia
Drooling
Distress

Question 5

Diagnosis

Answer 5

Do NOT examine the airway or distress the child
FIRST LINE + GOLD STANDARD = Laryngoscopy - can also be therapeutic as intubation can be performed at the same time if needed
Lateral neck radiograph - THUMB SIGN
- a normal radiograph does not rule out Epiglottitis
Bloods - inflammatory markers raised

Question 6

Management

Answer 6

FIRST LINE = Secure the airway
- Airway compromise: urgently contact anaesthetics for endotracheal intubation,
- If intubation fails due to excessive oedema - surgical airways required = cricothyrotomy
- Airway maintained: if low risk of obstruction then intubation not necessary and humidified oxygen is given
Nebulised adrenaline: emergency to minimise laryngeal oedema prior to intubation
Intravenous antibiotics: typically broad-spectrum antibiotics such as CEFTRIAXONE
SECOND LINE = Dexamethasone

Question 7

Complications

Answer 7

Airway obstruction
Mediastinitis
Soft tissue involvement: cellulitis or abscess within the neck