Epiglotitis

Question 1

What is acute epiglottis?

Answer 1

Rapidly progressive infection causing inflammation of the epiglottis & tissues around that may lead to abrupt blockage of the upper airway and death.

Question 2

What causes acute epiglottis?

Answer 2

Haemophilus Influenza B.

=> rare now due to Hib vaccination

=> children can still present with this if missed vaccination or born overseas with poor immunisation coverage

Question 3

Who does acute epiglottis affect?

Answer 3

Common in children aged 1-6 years (similar age group to croup)

Question 4

How does acute epiglottis present?

Answer 4

=> rapid onset

=> high fever

=> generally unwell / septicaemia

=> intensely painful throat - prevents child from speaking or swallowing; saliva drools down chin

=> soft inspiratory stridor

=> rapidly increasing respiratory difficulty over hours

=> ‘tripod’ position: child sits immobile, upright with open mouth to optimise airway

=> cough minimal / absent

Question 5

How is acute epiglottis diagnosed?

Answer 5

1. Diagnosis is made by direct visualisation.
2. X-ray may be done esp if there is concern about foreign body
   => lateral view in acute epiglottis shows swelling of the epiglottis - the ‘thumb sign’

=> posterior-anterior view in croup will show subglottic narrowing - the ‘steeple sign’

Question 6

How is acute epiglottis managed?

Answer 6

Paediatric emergency - Get senior help (paeds reg/consultant, ENT, anaesthetist, alert ITU)

=> Secure the airways - endotracheal intubation

=> once airway is secure, take cultures and examine throat

=> treat with IV antibiotics: cefuroxime

=> oxygen

*if acute epiglottis expected = do NOT examine the throat before securing it due to risk of acute airway obstruction