Epiglottitis: The Daily PANCE Blueprint

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Epiglottitis: The Daily PANCE Blueprint

A 2-year-old male presents to the ER with his parents. The mother says he had a cold for a few days with a cough and fever, but he recently got much worse over the past few hours. He has started drooling and tripoding. Vitals reveal a fever (102 F) and hypoxemia (SpO2 84% on room air). On physical exam you hear audible stridor. What is the next best step in the management of the patient?

A. Secure an airway
B. Start intravenous antibiotics
C. Order lateral neck radiographs
D. Place a laryngeal mask airway
E. Obtain blood cultures

Answer and topic summary

The answer is A. Secure an airway

Epiglottitis is inflammation of the epiglottis and adjacent structures most commonly due to infection. The supraglottic swelling causes turbulent airflow during inspiration (aka stridor) and can even lead to complete airway obstruction. Common bacterial causes include Haemophilus influenzae type b and Streptococcus pneumoniae. Clinical features include fever, drooling, stridor, muffled voice, severe sore throat, and toxic appearance (agitation, restlessness). A lateral neck radiograph may show the classic “thumbprint sign” of an edematous epiglottis. If needed, the airway should be promptly secured BEFORE any interventions are done (ideally intubated by an expert otolaryngologist in the OR). The antibiotics of choice include a third-generation cephalosporin (ceftriaxone) and anti-staph agent

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒Infectious Pulmonary Disorders ⇒ Acute epiglottitis

Also covered in the Emergency Medicine PAEA EOR content blueprint

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