Epiglottitis: Difference between revisions
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*O2 (humidified) | *O2 (humidified) | ||
*IVF (hydration minimizes crusting in the airway) | *IVF (hydration minimizes crusting in the airway) | ||
*[[Ceftriaxone]] 2gm IV | *Nebulized [[Epinephrine]] to reduce edema | ||
**Consider Vancomycin | ===Antibiotics=== | ||
;Empiric coverage for Streptococcus pneumoniae, Staphylococcus pyogenes, and Haemophilus influenzae | |||
*[[Ceftriaxone]] 2gm IV is first line | |||
**Consider [[Vancomycin]] in patients at risk for [[MRSA]]<ref>Young LS, Price CS. Complicated adult epiglottitis due to methicillin-resistant Staphylococcus aureus. Am J Otolaryngol. Nov-Dec 2007;28(6):441-3.</ref> | |||
*[[Intubation]] | |||
===Steroids=== | |||
[[Methylprednisolone]] 125mg IV | |||
===Airway Managment<ref>Katori H, Tsukuda M. Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol. Dec 2005;119(12):967-72</ref>=== | |||
*First line therapy is fiberoptic [[Intubation]] | |||
*Preparation should be made for simultaneous [[cricothyrotomy]] incase intubation fails | |||
==Disposition== | ==Disposition== | ||
*Admit | *Admit with ENT notification | ||
==Source== | ==Source== | ||
*Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol. Aug 2008;122(8):818-23 | |||
[[Category:Peds]] | [[Category:Peds]] | ||
[[Category:ID]] | [[Category:ID]] |
Revision as of 09:42, 24 May 2014
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)
- Nebulized Epinephrine to reduce edema
Antibiotics
- Empiric coverage for Streptococcus pneumoniae, Staphylococcus pyogenes, and Haemophilus influenzae
- Ceftriaxone 2gm IV is first line
- Consider Vancomycin in patients at risk for MRSA[1]
Steroids
Methylprednisolone 125mg IV
Airway Managment[2]
- First line therapy is fiberoptic Intubation
- Preparation should be made for simultaneous cricothyrotomy incase intubation fails
Disposition
- Admit with ENT notification
Source
- Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol. Aug 2008;122(8):818-23