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Acute Epiglottitis

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Anaesthetics and Critical Care

Obstetrics Gynaecology

Trauma and Orthopaedics

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Urology

Version Jan 2023

Related Subjects: |Acute Epiglottitis |Croup |Acute Tracheitis |Stridor

Important cause of stridor in a child and in the adult can be fatal too. It should be treated as a surgical emergency until the airway is examined and secured as a tracheostomy may be needed. Do not examine airway without senior anaesthetic and airways support if diagnosis considered

About

Acute epiglottitis is a paediatric medical emergency you must know about
Increasingly rare due to the use of Hib vaccination

Aetiology

Haemophilus influenzae infection
Risks are non-vaccination with Hib vaccine and immunocompromised
Also seen in adults where it is under-recognised

Clinical

Classical signs are the 2-6 year or older with a severely sore throat
However it can occur at any age!
Painful dysphagia and often unable to speak or swallow
Adopts 'tripod' position of the patient, drooling, high fever
Toxic appearance, Fever, flushed and generalised infection.
The symptoms have come on in a matter of hours.
Silent, drooling and unable to swallow saliva with a fever of over 38.5 C
Soft and quiet stridor

Investigations (Bloods not done until airway secure)

↑ WCC ↑ CRP. Mild ↑ Creatinine if dehydrated
Lateral, soft tissue radiograph may show a thickening of the epiglottis (thumbprint sign)
MRI: once stable may show enlargement of epiglottis
Direct visualisation by endoscopy

Differential: Comparison of Croup vs Epiglottitis and Tracheitis

	Croup	Tracheitis	Epiglottitis
Cause	Viral	Staphyloccocus aureus Streptococcus	Haemophilus influenzae B
Age	6m - 3yr	Any age	2 - 6 yr
Onset	Gradual	Gradual	Sudden
Pyrexia	Mild	>38^oC	>38^oC
Abnormal sounds	Barking cough, stridor	Barking cough, stridor	Muffled, gutteral cough
Swallowing	Normal	Difficult	Very difficult with drooling
Posture	Recumbent	Sitting	Tripod position
Facies	Normal	Anxious	Anxious, distressed, toxaemic

Management

Quickly start 15 l/min humidified Oxygen and call for help.
Do not examine the throat, Do not cannulate but summon anaesthetic help to manage the airway. Call a senior anaesthetist/paediatrician/ENT surgeon immediately.
May require a surgical airway and if formal intubation is not possible then tracheostomy is performed. Patient can be admitted to a high dependency area on the ENT ward
Start IV antibiotics. Steroids not indicated.
Prevent with Hib vaccination for Haemophilus influenzae type b infection

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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