Epiglottitis

Last Updated on by FRCEM Intermediate

Overview

  • Epiglottitis has been eradicated since the introduction of the Hib vaccine (Hib as part of the 5 in 1 DTaP/IPV/Hib vaccine)
  • vaccine: 2,3,4 months.Hib/Men C “booster” vaccine at 12 months.
  • Bacterial

Clinical features

  • Pyrexia, sore throat, muffled speech, drooling and stridor
  • sitting forwards neck extended, mouth open, drooling with tongue protruding

Investigations

  • Fibre-optic laryngoscopy remains the ‘gold standard’ for diagnosing epiglottitis, should only be performed in operating theatres which are prepared for intubation or tracheostomy in the event of upper airway obstruction.
  • Lateral neck X-ray: ‘thumbprint sign’
  • CT or MRI scans if abscesses suspected
  • Blood culture, thorat swap  if unwell

Management

  • Keep calm: Do not distress the child as this can precipitate complete airway obstruction
  • Oxygen if hypoxic
  • IV antibiotics if intravenous access can be achieved without distress
  • call anesthetist with an ENT surgeon: Children under 6 years of age require urgent intubation, ideally in theatre
  • Keep difficult intubation trolley and cricothyroidotomy kit must be ready.

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