Acute Epiglottitis
Acute Epiglottitis Complications
*Airway obstruction* Epiglottic abscess (from secondary infection) Necrotizing epigltottis (in immundeficient) Death
Acute Epiglottitis PE Findings
*Febrile* (57%) General appearance: -*appear toxic* -restless/anxious, -*"tripod"* or "sniffing" position -*drooling* -neck is hyperextended & chin thrust forward -*speech muffled* Lungs: inspiratory stridor, poor air entry, Neck: tenderness anterior neck (38%)
Acute Epiglottitis Pathophysiology
*Inflammation of the epiglottis & adjacent *supra*glottic structures* Supraglottic/epiglottic swelling narrows the upper airway, causing turbulent airflow on *inspiration (stridor)*
Hallmark Signs of Acute Epiglottitis in Children
*Muffled speech; "hot potato voice" (79%)*
Acute Epiglottitis Clinical Features
*Respiratory distress* Anxiety *Dyspnea (80%)* Dysphagia (26%) *Drooling* Sudden onset high fever (38‐40C) (57%) Severe pharyngitis (73%) *Muffled speech*; "hot potato voice" (79%) *Stridor* (80%) -*Don't want to eat or drink*
Medical Emergency
Acute Epiglottitis
Acute Epiglottitis Risk Factors
Children -*Incomplete or lack of immunity to Hib* -*Immunodeficiency* Adults: -HTN -DM -Substance abuse -Immunodeficiency
Acute Epiglottitis
Children -Haemophilus influenzae type b (*Hib*)
Acute Epiglottitis Dx Criteria
Confirmed by *visualization of erythematous, edematous epiglottis* OR Confirmed by demonstration of *epiglottal edema on lateral neck radiograph* (Thumb Print Sign!)
Acute Epiglottis Triad
Drooling Dysphagia Distress
Abx Acute Epiglottitis
Empiric therapy to cover: Hib *Ceftriaxone* PLUS anti‐MRSA antibiotic (*Vancomycin*) First‐generation cephalosporin (cefazolin) or antistaphylococcal PCN if not concerned about MRSA
Thumb Print sign
Enlarged Epiglottis
Acute Epiglottitis Prevention
Haemophilus influenzae type B (Hib) *vaccine*
Acute Epiglottitis Management
Monitor closely by clinician who can do *rapid endotracheal intubation & rescusitation* *Maintenance of airway* Administration of appropriate antimicrobials Once airway is secured -CBC with diff (increased bands, neutrophils, L SHIFT!) -Blood and epiglottis cultures
Do patients with Acute Epiglottis have a barking cough?
No!
Acute Epiglottitis Dx Studies
Visualization of epiglottis -Direct visualization of the epiglottis is diagnostic -*Caution!* Perform only in *ED, OR or ICU* -Via pharyngoscopy w tongue blade -*Manipulation in children may initiate sudden, fatal airway obstruction!!* -Via fiberoptic nasolaryngoscopy -Pooled secretions, inflammation, edema of supraglottic structures
