Epiglottitis Flashcards
What is epiglottitis?
An acute life threatening condition
Inflammation of the epiglottis
What is the epiglottis?
Flap of cartilage behind the tongue
What is the function of the epiglottis?
Designed to protect the larynx during swallowing
What causes epiglottitis?
Infection - streptococcus pneumoniae, haemophilus influenzae. HSV, parainfluenza, VZV, HIV, EBV
Trauma
Thermal/chemical damage
Where does the inflammation of epiglottitis start?
Lingual surface of epiglottis before spreading to aryepiglottic folds, arytenoids and supraglottic larynx
Describe how the structure of the vocal cords results in airway obstruction in epiglottitis
Tightly bound epithelium which restricts progression of swelling and increases pressure in the small area
Why are children more at risk of airway obstruction from epiglottitis than adults?
Anatomy - the epiglottis is floppy, larger, longer, broader and angled more obliquely to the trachea compared to adults. Larger tongue and anteriorly angled vocal cords - air is more difficult to move even in partial obstruction
What are the risk factors for epiglottitis?
Not having the HiB vaccination
Male
Immunosuppression
When is the HiB vaccination given?
8,12,16 weeks and 1 year
List the clinical features of epiglottitis
Dyspnoea Dysphonia - muffled hot potato voice Drooling Dysphagia High grade fever Sore throat Dehydration Stridor is a late sign Tripod position - attempt to position inflamed structures out of the way of the airway
How long is the symptom duration of epiglottitis
<12hours
List some differentials of epiglottitis
Croup Inhaled foreign body Retropharyngeal abscess Tonsillitis Peritonsillar abscess Diphtheria
What investigations should be done for epiglottitis
Secure airway first Throat swabs Bloods - FBC, CRP, cultures Lateral neck X-ray - thumb print sign (swollen epiglottitis), thickened aryepiglottic folds, increased opacity of larynx and vocal cords CT/MRI
Describe the management of acute epiglottitis
Secure the airway - early escalation to ENT, anaesthetics and avoid distressing the child in the mean time
Oxygen - get parent to hold the mask close to child’s face
Nebulised adrenaline - Bridging therapy whilst awaiting definitive airway management by reducing oedema of the upper airway mucosa
IV antibiotics - 3rd generation cephalosporins (cefotaxime or ceftriaxone). Once stable and extubated convert to oral antibiotics - co-amoxiclav
IV steroids - benefit not yet proven but thought to reduce inflammation
IVI - resuscitation and maintenance. Patients should be NBM until airway improved
List the complications of epiglottitis
Mediastinitis Deep neck space infection Pneumonia Meningitis Sepsis
