Epiglottitis

Other distinguishing features

Acute Epiglottitis in adults is typically seen in patients with neck trauma (blunt force trauma, neck injury, or aspiration of hot liquids) in patients who have had frequent intubations, and in drug abuse cases such as cocaine abuse

Causes / Etiology

Acute Epiglottitis is a bacterial infection that is almost always caused by Haemophilus influenzae B Boys more affected than girls Onset quick and abrupt Initial signs usually mild but progress rapidly (2-4 hrs.) A common scenario includes child having a sore throat or mild upper respiratory problems that quickly progress to a high fever, extreme tiredness, difficulty swallowing, and handling secretions, the child usually appears pale, and septic As the supraglottic area becomes more swollen the child's tongue may be thrusted forward and they may drool Cough is usually absent with acute Epiglottitis The voice and cry are usually muffled rather than hoarse Older children usually complain of sore throat during swallowing

Anatomic Changes to the Lungs

Airway obstruction caused by tissue swelling above the vocal cords Supraglottic airway obstruction Inflammation of the supraglottic region, aryepiglottic folds, and false vocal cords As the edema in the epiglottis increases, the lateral borders curl and the tip of the epiglottis protrudes posteriorly and inferiorly, during inspiration the swollen epiglottis is pulled over the laryngeal inlet, in severe cases this may completely block the laryngeal opening

Breath Sounds

As the supraglottic area becomes swollen breathing becomes noisy the tongue is often thrust forward during inspiration (child may drool) Inspiratory stridor is usually softer and lower in pitch compared to croup

Other physical assessment findings

Classic signs: *Cherry Red Epiglottis *Severe Respiratory Distress *Drooling Factors that lead to increased ventilatory rate *Increase stimulation of peripheral chemoreceptors *Anxiety * Increased Temperature secondary to infection Factors that may lead to development of cyanosis *Intermittent coughing spells may produce intermittent cyanosis as secretions obstruct an already limited airway Other Physical Findings *Use of accessory muscles during inspiration Substernal and intercostal retractions

Abnormal labs expected

Diagnosed by looking at physical findings and X-rays

Sputum characteristics

Difficulty with swallowing and handling secretions (unlike croup)

Treatment and/or management

Examination and inspection should only be done in the operating room with trained staff to prevent further narrowing of the airway Antibiotic therapy since acute Epiglottitis is almost always caused by H. Influenzae type B Ceftriaxone (Rocephin) and Amoxicillin/sulbactam (Unasyn) are often prescribed to cover the most common organisms that cause Acute Epiglottitis Epiglottitis is a true Airway Emergency early recognition is critical If patient is anxious, restless, or uncooperative restraints and sedation may be needed to prevent self- extubation

Chest X-Ray or CT results

Haziness in supraglottic region Classic "thumb sign" (the manifestation of an edematous and enlarged epiglottis seen on lateral neck radiograph)

Heart Rate, Respiratory Rate, Blood Pressure, Temperature (normal, high, low)

Heart Rate: Increased Respiratory Rate: Increased Blood pressure: Increased Temperature: Increased (secondary to infection)

ABG results

Mild to Moderate Epiglottitis Acute Alveolar Hyperventilation with Hypoxia Respiratory Alkalosis with decreased HCO3- (but still in normal range) Severe Epiglottitis Acute Ventilatory Failure with Hypoxemia Respiratory Acidosis with increased HCO3- (but in normal range

National or Global guidelines or protocols

Patient who has a confirmed diagnosis of Acute Epiglottitis should be intubated immediately Supplemental oxygen protocol Endotracheal/Tracheostomy

Risk factors

The patient usually maintains limited airway by sitting up and leaning forward with chin protruding laying patient down will cause complete airway obstruction in minutes Properly trained staff members are critical to patient survival

Prevention

Transmitted via aerosol droplets Hand hygiene Wearing masks Gloves