Epiglottis

Question 1

Definition

Answer 1

Inflammation and localised oedema of the epiglottis leading to potentially life-threatening airway obstruction.

Question 2

Aetiology

Answer 2

Unvaccinated: Haemophillius influenzae B
Vaccinated: -
- Streptococcus pneumoniae,
- Streptococcus Pyogenes

Question 3

Epidemiology

Answer 3

Age: 6-12 years
Male
Unvaccinated
Immunocompromised

Question 4

Signs

Answer 4

Stridor
Respiratory distress:
- intercostal and subcostal recession
- tracheal tug
- nasal flaring
- accessory muscle use
Pyrexial ~ 40°C
Tripod position = patient leans forward and supports their upper body on their knees
Toxic looking

Question 5

Symptoms (5 D’s)

Answer 5

• rapiD onset
• Dysphagia
• Dysphonia (stridor)
• Drooling
• Distress

Question 6

Diagnosis

Answer 6

DO NOT EXAMINE AIRWAY - Can lead to airway occlusion and respiratory arrest
- FIRST LINE AND GOLD STANDARD: Laryngoscopy - will demonstrate swelling and inflammation of the epiglottis as well as therapeutic as intubation can be performed at the same time if needed
- Lateral neck radiograph: thumb sign

Question 7

Treatment

Answer 7

FIRST LINE: Secure airway
- Airway compromise = anaesthetic endotracheal intubation if fails cricothyrotomy
- Airway maintained = humidified oxygen
Nebulised adrenaline = minimise laryngeal oedema prior to intubation
IV Abx: Broadspec e.g CEFTRIAXONE
Second line: DEXAMETHASONE

Question 8

Complications

Answer 8

Airway obstruction
Mediastinitis: infection can track along the retropharyngeal space and involve the mediastinum, which is associated with a poor prognosis
Soft tissue involvement: cellulitis or abscess within neck