Epiglottitis Flashcards

1
Q

What is epiglottitis?

A

Epiglottitis is acute inflammation of the epiglottis, which can rapidly progress to severe airway obstruction, usually associated with significant systemic illness.

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2
Q

anatomically, where is the epiglottis?

A

The epiglottis is a cartilaginous flap located in the larynx

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3
Q

What is the epiglottitis’’ function?

A

Its function is to close over the opening to the airway (glottis) during swallowing. This prevents food or liquids from passing into the trachea and the lungs.

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4
Q

What can inflammation of the epiglottis lead to?

A

Airway obstruction

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5
Q

What is the most common cause of epiglottitis?

A

Infection

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6
Q

What pathogen is the most common cause for epiglottitis?

A

Haemophilus influenzae type b (Hib)

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7
Q

What has reduce the incidence of epiglottitis?

A

Hib Vaccine

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8
Q

What other organisms can cause epiglottitis?

A

streptococcus pneumoniae, group A streptococci and staphylococcus aureus

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9
Q

Can virus’ cause epiglottitis?

A

Yes but is rare

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10
Q

What are 3 examples of viral causes of epiglottitis?

A
  1. Herpes simplex virus
  2. Infectious mononucleosis
  3. Fungal infections like candida
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11
Q

What are some non-infectious causes?

A
  1. Thermal injuries
  2. Chemical burns
  3. Foreign body ingestion
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12
Q

What are 4 risk factors for epiglottitis?

A
  1. Individuals without the Hib vaccine
  2. Immunocompromised patients
  3. Men in mid-40s
    Additional co-morbidities
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13
Q

What are typical symptoms of epiglottitis?

A

Severe and acute onset of sore throat
Muffled voice
Drooling
Inspiratory stridor
Difficulty swallowing (dysphagia) and/or painful swallowing (odynophagia)

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14
Q

What do most patients also report alongside epiglottitis?

A

A recent upper respiratory tract infection (URTI)

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15
Q

Do adults or children often present with a slower less severe set of symptoms?

A

Adults

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16
Q

During clinical examination, why should no action be taken to stimulate or irritate the patient?

A

Because it may trigger a laryngospasm in an already critical airway.

17
Q

What can the symptom of a muffled voice often be referred to as?

A

Hot potato voice

18
Q

What position is common amongst patients with epiglottitis?

A

Tripod position: sitting up on hands, with the mouth open and head forward to increase airflow (commonly seen in children)

19
Q

What other clinical findings are typically present?

A

Drooling (more common in children)

Signs of respiratory distress: dyspnoea, tachypnoea, use of accessory muscles and cyanosis are severe findings and indicate impending respiratory failure (seen in both children and adults)

Inspiratory stridor: can sometimes be a late finding and indicates advanced upper airway obstruction.

Hypoxia

Tachycardia

Fever

20
Q

What are some differential diagnoses’ of a sore throat?

A
  1. Acute tonsilitis
  2. Acute pharyngitis
  3. Peri-tonsillar abscess (Quinsy)
  4. Deep neck space infection
21
Q

What are some differential diagnoses’ of stridor?

A
  1. Laryngotracheobronchitis (Croup)
  2. Foreign body inhalation
  3. Anaphylaxis
  4. Laryngitis
22
Q

Why are investigations in the immediate period avoided unless the patient is stable?

A

The condition is time critical

23
Q

What are the investigations if there is a strong clinical suspicion of epiglottitis in an unstable patient?

A

they will likely be taken to a controlled environment, such as the operating theatre, for examination of the airway plus endotracheal intubation or a surgical airway.

24
Q

Once the airway is secure, what other further laboratory investigations can be carried out?

A
  1. Blood tests
  2. Blood cultures
  3. Culture swab from epiglottis
25
Q

What are the first-line investigations in a stable patient?

A

direct flexible (or rigid) laryngoscopy to visualise the airway.
Normally performed by ENT, this confirms swelling and inflammation of the epiglottis and inflammation of surrounding supraglottic structures.

26
Q

What is used to secure the airway during investigations?

A

endotracheal intubation or an emergency surgical airway (i.e. tracheostomy)

27
Q

What is the second-line imaging for epiglottitis?

A

lateral neck radiograph

28
Q

What is referred to as the ‘thumbprint sign’ found on a lateral neck radiograph?

A

severely swollen epiglottis

29
Q

What is the main priority in management of epiglottitis?

A

The main priority is to secure the airway in a controlled environment, as patients (particularly children) can deteriorate quickly.

30
Q

What is the treatment of epiglottitis?

A

they will be managed in critical care with monitoring, IV antibiotics and subsequent extubation in a controlled setting.

31
Q

What does additional management include?

A
  1. Nebulised adrenaline
  2. High-flow oxygen
  3. Intravenous broad-spectrum antibiotics
  4. Corticosteroids
  5. Fluid replacement therapy
  6. Analgesia
32
Q

What intravenous broad-spectrum antibiotics are used to treat epiglottitis?

A

a third-generation cephalosporin (e.g. ceftriaxone or cefuroxime) is often used

33
Q

Why are corticosteroids used as treatment?

A

e.g., dexamethasone): usually given as a stat dose on acute presentation.
corticosteroids may help reduce supraglottic inflammation.

34
Q

What are 3 complications of epiglottitis?

A
  1. Epiglottitis abscess
  2. Deep neck space infections
  3. Mediastinitis
35
Q

Why is epiglottitis an emergency condition?

A

Epiglottitis represents a life-threatening condition which can quickly lead to severe airway obstruction with high mortality.