Epiglottitis

what kind of lab should be order for suspect epiglottitis?

1. CBC with differential, often leukocytosis with a shift to the left and bandemia. 2. Blood cultures to guide antibiotic therapy. 3. Culture and sensitivity 4. ABGs

what are the risk factors for epiglottitis?

1. foreign body aspiration 2. lacking adequate vaccinations Hib. 3. immunosuppression

what are noninfectious causes of epiglottitis?

1. inflammation in association with thermal injury like crack cocaine, marijuana smoking. 2. ingestion of caustic substances like automatic dish washing detergent. 3. systemic disease like Diabetes, hypertension, obstructive pulmonary disease, seizure disorder, alcohol, tobacco and drug abuse. 4. chemotherapy of head and neck cancer, trauma by foreign objects, and burns associated with bottle feed infants formula.

Non-pharmacologic therapy used for epiglottitis?

1. sit up right in quiet environment. 2. humidified oxygen, and airway equipment at beside. 3. close observation of airway 4. continuous oxygen therapy and monitoring of oxygen saturation. 5. hospitalization in intensive care 6. intravenous broad spectrum antibiotics and in some cases steroids. 7. immediate consultation with otolaryngology. 8. avoid sedation, racemic epinephrine, inhaled medications.

what other pathogens that can cause epiglottitis besides Haemophilus influenzae type B?

1. streptococcus species Group A, B, C. 2. staphylococcus aureus 3. Viral pathogens 4. streptococcus pneumoniae 5. klebsiella pneumoniae 6. Haemophilus parainfluenzae 7. Neisseria meningitis 8. varicella zoster virus

how long should the antibiotic be prescribed?

10 to 14 days

The mean age of adults with epiglottitis is?

44.94 years

What is the epigottitis?

A life threatening infection of the epiglottis and surrounding tissues that can cause sudden narrowing of the airway. Supraglottitis is an acute inflammation of the supraglottic region of the oropharynx. The inflammation and edema of the epiglottis, vallecular, arytenoids and aryepiglottic folds. high vascularity and loose mucosa of the epiglottic region, sudden airway obstruction and possible death can result. Cause laryngospasm and irrevocable loss of the airway.

how is Ludwig angina diagnosed?

CT Scan

what are the signs and symptoms of Ludwig angina?

Fever dysphagia inability to swallow stridor typically results of a dental infection

What are the usual signs of epiglottitis in children?

Fever is usually the first symptom. dyspnea, stridor, anxiety. restlessness, cough beef red pharynx and anterior neck tenderness, lymphadenopathy. Drooling or spitting, unable to swallow and muffled voice or hoarseness. Respiratory distress sniffing posture or tripod position and accessory muscles use.

The most common bacterial pathogen that is responsible for epiglottitis is?

Haemophilus influenzae type B (Hib)

The dramatic decline in childhood epiglottis is due to what?

Haemophilus influenzae vaccine

what is the gold standard for a definitive diagnosis of epiglottitis?

It is made by direct visualization via laryngoscopy with a flexible fiberoptic scope or a laryngeal mirror.

what diagnostic studies would be done for epiglottitis?

Lateral neck X-ray, CBC

tripod position

The patient leads forward, bracing hands on the knees.

sniff posture

The patient leans forward and hyperextends neck to maintain patent airway.

what does toxic appearance mean?

The patient looks pallor, cyanosis, tachycardia, tachypnea, nasal flaring.

what medications would be used for epiglottitis?

The use of 2nd or 3rd generation cephalosporins like ceftriaxone, cefotaxime, ampicillin sulbactam, clindamycin or levofloxacin.

If the epiglottitis is MRSA or sepsis is concerned, what antibiotic should be used?

Vancomycin

even though epiglottitis affects children it can also what?

affect any age including adults

The most common age that epiglottitis affects?

age greater than 7 years old, sometimes age 3 -6 years.

what are some differential diagnosis of epiglottitis?

bacterial tracheitis, foreign body aspiration, peritonsillar abscess infections, Ludwig angina, tumor, trauma, retropharyngeal infections, caustic ingestion, allergic drug reactions, laryngeal trauma, uvulitis, angioedema, thermal injury, GERD, illicit drug use.

Mortality rate for adults with epiglottitis?

between 6% to 7%

what is the key sign of epiglottitis in children?

drooling

what are the usual signs of epiglottitis in adults?

first fever is the first symptom, then predominant symptoms like odynophagia pain with swallowing and dysphagia, voice changes or hoarseness or muffled voice. Dyspnea, tachypnea, stridor, anxiety, restlessness, cough, beef red pharynx, anterior neck tenderness, lymphadenopathy. Drooling or spitting saliva, inability to swallow secretions. Respiratory distress, sniffing posture or Tripod position. use of accessory muscles.

If you suspect epiglottitis in any age group what should NP do?

immediate referral to an emergency department capable of airway support and consult otolaryngology.

What is peritonsillar abscess?

infection between the tonsil and pharyngeal constrictors caused by Strep. pyogenes, Staph. aureus, and/or Bacteroides spp

what is thermal epiglottis?

it is a rare and potentially life threatening disease caused by direct thermal injury or inhalation of steam or aspiration of heated liquids. crack cocaine has been associated with thermal injury in teens and young adults.

What is Ludwig angina?

it is a severe diffuse form of cellulitis with an acute onset affecting the submental, sublingual, or submandibular spaces.

Mortality rate for children with epiglottitis?

less than 1%

What is retropharyngeal abscess?

life-threatening infection in the lateral pharyngeal space that has the potential to occlude the airway; most commonly occurs in children. Identified by CT Scan.

if anaerobic bacteria is suspected with epiglottitis, what antibiotic should be added?

metronidazole

what complications that can occur with epiglottitis?

potentially fatal condition other fatal complications such as septicemia, meningitis, pulmonary edema, epiglottic abscess, vocal cord granuloma, pneumomediastinum.

Many experts advocate the use of what to help decrease airway inflammation edema?

steroids

Lateral X-ray of the neck or epiglottis is performed. What are you looking for if the patient has epiglottitis?

thumb print sign on x-ray.

Do not attempt to visualize the pharynx if epiglottitis is suspected with a what?

tongue depressor

Toxemia means

toxins in the blood