Epiglottitis21-22
a. Definition: Life-threatening, rapidly progressive inflammation (usually
infectious) of the supraglottic region
(1) Most often affects children between 1 and 8 years but may occur
at any age
(2) May be caused by infection, thermal injury, caustic ingestion, or
foreign body
(3) Most common infectious organisms include Haemophilus
influenzae (unvaccinated), Streptococcus pneumoniae, group A
streptococci, and Staphylococcus aureus.
(4) Patients often present febrile, toxic-appearing, and tripoding in
respiratory distress. Drooling, dysphagia, and inspiratory stridor
are common. Barky cough is absent.
b. Management: Avoid any agitation of the child prior to securing airway
to prevent impending complete obstruction.
(1) Allow child to assume a position of comfort. Unobtrusively
provide blow-by oxygen. Monitor with pulse oximetry.
(2) To secure airway, emergently consult difficult airway personnel
(pediatric anesthesiologist, intensivist, and/or
otolaryngologist).
(a) If unstable (unresponsive, cyanotic, bradycardic), emergently
intubate.
(b) If stable with high suspicion, escort patient to OR for
laryngoscopy and intubation under general anesthesia.
Equipment for tracheotomy should be readily available.
(c) If stable with moderate or low suspicion, obtain lateral neck
radiograph to assess for “thumb sign” of an inflamed
epiglottis.
(3) Initiate broad-spectrum antibiotic therapy (e.g., vancomycin and
ceftriaxone).