Acute Epiglottitis
Presented by ‘Kawe
Introduction
• Acute epiglottitis is the result of localized infection of the
supraglottic larynx, usually by Haemophilus influenzae.
• This results in swelling of the epiglottis that obstructs the
laryngeal inlet.
• If there is suspicion of acute epiglottitis the child should be
admitted immediately because of the danger of airway
obstruction.
Clinical features
In children, possible clinical features include:
• patient is usually 2 to 6 years old;
• unwell; grey in colour - the child looks septic
• voice is muffled
• if the child coughs it may sound like a "quack"
• child is quiet and terrified
• increasing dysphagia
• drooling
• stridor - of rapid onset and the child will prefer to sit upright and
lean slightly forwards in an attempt to maintain the airway. The
stridor may be fairly quiet.
Clinical features
In adults, possible clinical features include:
• as above, except that the onset is usually slower; the recovery
is also slower
• the principal complaint may be of a severe pain that is worse on
swallowing.
• This condition may be fatal in either children or adults.
management
admit immediately to hospital
• don't examine throat - this is likely to provoke spasm and cause
obstruction
• minimise distress to the child - don't separate from parents or give
antibiotics
• contact the hospital so they can arrange a senior anaesthetist to
intubate the patient and an ENT surgeon to perform a tracheostomy
if needed
• nebulised adrenaline can be used
• go with the child to hospital if possible
• be prepared to do an emergency laryngotomy in case of obstruction
• when obstruction is imminent, stridor becomes ominously quieter
management
• treatment for confirmed diagnosis is chloramphenicol, or
cefotaxime, dependent upon sensitivities of local Haemophilus
influenzae B strain. Empirical treatment of choice is often
chloramphenicol
Epiglottitis vs
Croup
• Thank you for listening