Acute_Epiglottitis_Flashcards
What causes Acute Epiglottitis?
Acute Epiglottitis is caused by Haemophilus influenzae type B.
Why has the incidence of Acute Epiglottitis decreased?
The incidence of Acute Epiglottitis has decreased due to the introduction of the Hib vaccine.
What are the common features of Acute Epiglottitis?
Features include rapid onset, high temperature, stridor, drooling of saliva, and adopting a ‘tripod’ position to ease breathing.
How is Acute Epiglottitis diagnosed?
Diagnosis is made by direct visualisation of the epiglottis by senior/airway trained staff, though X-rays showing the ‘thumb sign’ can also be used.
What is the ‘thumb sign’?
The ‘thumb sign’ is seen on a lateral view X-ray of the neck and indicates swelling of the epiglottis in Acute Epiglottitis.
What is the management protocol for Acute Epiglottitis?
Management includes immediate senior involvement, possible endotracheal intubation to protect the airway, avoidance of throat examination, administration of oxygen, and intravenous antibiotics.
summary
Acute epiglottitis
Acute epiglottitis is rare but serious infection caused by Haemophilus influenzae type B. Prompt recognition and treatment is essential as airway obstruction may develop. Epiglottitis was generally considered a disease of childhood but in the UK it is now more common in adults due to the immunisation programme. The incidence of epiglottitis has decreased since the introduction of the Hib vaccine.
Features
rapid onset
high temperature, generally unwell
stridor
drooling of saliva
‘tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position
Diagnosis is made by direct visualisation (only by senior/airway trained staff, see below). However, x-rays may be done, particularly if there is concern about a foreign body:
a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’
in contrast, a posterior-anterior view in croup will show subglottic narrowing, commonly called the ‘steeple sign’
Management
immediate senior involvement, including those able to provide emergency airway support (e.g. anaesthetics, ENT)
endotracheal intubation may be necessary to protect the airway
if suspected do NOT examine the throat due to the risk of acute airway obstruction
the diagnosis is made by direct visualisation but this should only be done by senior staff who are able to intubate if necessary
oxygen
intravenous antibiotics
Laz summary of acute epiglottis
A 5-year-old boy from a travelling community presents to the Emergency Department with breathing difficulties. On examination he has a temperature of 38.2ºC, stridor and a toxic looking appearance. A diagnosis of acute epiglottitis is suspected. Which one of the following organisms is most likely to be responsible?
Epstein Barr Virus
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Staphylococcus aureus
Haemophilus influenzae
Acute epiglottitis is caused by Haemophilus influenzae type B
Patients from travelling communities may not always receive a full course of immunisation
