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)
- 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