Epiglottitis

Background

• Otolaryngologic emergency
  • Can lead to rapid onset of life-threatening airway obstruction
• Most cases are seen in adults (since advent of H. flu vaccine)
• Etiology
  • Strep, staph, H. flu (unvaccinated)
  • Caustic burns

Clinical Features

• Three D's:
  • Drooling
  • Dysphagia
  • Distress
• Pain with gentle palpation of larynx and upper trachea
• Stridor
• Respiratory distress

Diagnosis

• Imaging only required if diagnosis uncertain
• Lateral neck x-ray
  • Obliteration of vallecula
  • Edema of prevertebral and retropharyngeal soft tissues
  • "Thumb sign" (enlarged epiglottis)

Treatment

• Emergent ENT consult
• O2 (humidified)
• IVF (hydration minimizes crusting in the airway)
• Ceftriaxone 2gm IV
  • Consider Vancomycin
• Nebulized epinephrine
• Steroids
  • Methylprednisolone 125mg IV
• Intubation or cricothyrotomy

Disposition

• Admit

Source

Tintinalli