Respiratory: Acute Epiglottits Flashcards
Is it a common or rare infection?
Rare
What causes it?
Haemophilius influenzae type B (Hib)
Why has the incidence decreased?
Due to the introduction of the Hib vaccine
Why is prompt recognition and treatment essential?
Airway obstruction may develop
What age group does it typically affect?
2 to 6 years
But can affect all age groups
Describe the onset
Very sudden onset
What features are associated with epiglottitis?
High fever - temperature > 38 Looks toxic Painful throat Dysphagia Drooling Soft stridor Muffled voice Rapidly increasing respiratory difficulty over hours Look anxious - still “sniffing dog”
How does the child sit?
Siting immobile, upright, with open mouth to optimise airway
In contrast to croup, what is minimal or absent?
Cough
What should NOT be done?
Lie the child down
Examine the throat with spatula
Perform lateral CXR
These can precipitate total airway obstruction and death
How should it be managed?
Urgent hospital admission and treatment
Senior paediatrician, ENT surgeon, anaesthetist summoned
Intubation of child under controlled conditions with a general anaesthetic
In rare cases: urgent tracheostomy is life saving
After airway is secured what can be done?
Blood culture
IV antibiotics - cefuroxime for 3-5 days
With appropriate treatment, when do most children recover?
Within 2-3 days
Who should prophylaxis with rifampicin be offered to?
Close household contacts
What would a lateral view CXR show?
Thumb sign - swelling of epiglottis
But CXR should not be done
Is there typically a preceding coryza?
No
Is the child able to drink?
No
Is haemophilius influenzae gram pos or neg?
Gram negative Secretes LPS (endotoxins)
Why is there drooling?
The child does not want to swallow due to the dysphagia
