Module 8.13 - Epiglottitis and Supraglottitis

Question 1

What is epiglottitis?

Answer 1

A rare, potentially life-threatening condition that occurs when the epiglottis becomes inflamed and swellings, blocking the laryngeal entrance and obstructing air flow to and from the lungs.

Question 2

What causes epiglottitis?

Answer 2

• Causative organisms most commonly H. Influenzae infection, but can be caused by penicillin-resistant S. pneumoniae, Beta-hemolytic streptococci and S. aureus
• Recent upper respiratory infection predisposes patients to epiglottitis

Question 3

What are the physical exam findings associated with epiglottitis?

Answer 3

A. Rapidly developing sore throat, fever, cough and difficulty swallowing

B. Muffled voice with drooling

C. Stridor and /or other signs of respiratory distress may be evident.

D. ‘Sniffing’ position- leaning forward while sitting to maximize airway opening.

E. Anxious

F. DO NOT examine the pharynx until:

1. Lateral soft tissue x-rays have been obtained, and
2. Emergency airway equipment is available (to prevent or treat laryngospasm)

Question 4

What laboratory/diagnostic tests are used to diagnose epiglottitis?

Answer 4

A. Lateral soft tissue neck x-ray – reveals a swollen epiglottis posteriorly displaced, known as the ‘thumb sign’ – refer to radiograph below- white arrow points to swollen epiglottis

B. CT scan of the neck may be needed.

C. Arterial blood gas analysis

D. Chest x-ray

E. CBC, blood cultures

F. Direct laryngoscopy by specialist

Question 5

How do you manage a patient with epiglottitis?

Answer 5

A. Management is guided by the apparent severity of respiratory distress.

B. Monitor the patient closely for complete airway obstruction.

B. Refer urgently for emergency care prior to performing any diagnostic physical evaluation.

C. ENT specialist and anesthesiologist should be consulted emergently.

D. Prepare for possible surgical opening of the airway.

E. Initial empiric therapy after cultures and smears have been submitted.

1. Third-generation cephalosporin (ceftriaxone or cefotaxime and an anti-staphylococcal, anti-MRSA agent (Clindamycin or vancomycin)
   a. Vancomycin dose is adjusted to achieve vancomycin level of 10-15mg/L
   b. Clindamycin 600mg IV q 8 hours
   c. Ceftriaxone (Rocephin) 1-2 grams IV q 24 hours, OR
   d. Cefotaxime (Claforan) 1-2 grams IV q 8 hours, AND
   e. Piperacillin/tazobactam, 3.375grams IV q 6 hours.

2. Clinical improvement usually occurs within 48-72 hours after antibiotic initiation.