- Epiglottitis is an acute inflammation of the epiglottis and other supraglottic structures that can lead to airway obstruction - Is a true airway emergency
- Haemophilus influenzae used to be the most common pathogen prior to the development of the Hib vaccine. Now, common pathogens include Streptococcus pneumoniae, Staphylococcus aureus, and beta-hemolytic streptococci.
- Due to immunizations against Haemophilus influenzae serotype b, epiglottitis has decreased in the pediatric population and is now more commonly seen between 30-50 years of age
- The most common chief complaint is Sore throat
Physical Exam
- Toxic-appearing, febrile, tachypneic, tachycardic, inspiratory stridor, muffled voice, drooling, anterior neck tenderness (hyoid bone)
Imaging
- Laryngoscopy is the most accurate method to establish the diagnosis
- Lateral soft-tissue radiograph of the neck is 88% sensitive. Image findings include a swollen epiglottis termed “thumb sign”. Absence of the “thumb sign” does not exclude the diagnosis
Evaluation and Management
- Diagnosis is clinical and confirmed with laryngoscopy.
- Early ENT consultation
- Patient should remain in a position of comfort. Avoid agitation as it may precipitate airway obstruction
- If respiratory distress or stridor is present, prepare for intubation.
- Intubation should be performed in the OR if the patient is stable for transport. For unstable patients, awake fiberoptic intubation is recommended with an anesthesiologist present at bedside.Intubation should be attempted by the most experienced physician.
- If intubation is unsuccessful, perform emergent cricothyroidotomy
- Antibiotics: Ceftriaxone (50 mg/kg up to 2 grams IV) and vancomycin (15 mg/kg for concern for MRSA) are a good choice. Trimethoprim- sulfamethoxazole is an acceptable alternative for patients with PCN allergy
- Decadron (0.1 mg/kg up to 10 mg IV).
- Disposition: ICU.
Sources:
EM docs, FOAM EM RSS