Lecture
Patient will present as → a 3-year-old boy who is brought to the ER with a sudden onset of fever (104.0 F), respiratory distress, and stridor. On examination, the boy appears acutely ill. He is sitting, leaning forward with his mouth open, he has a muffled voice and is drooling. When asked the parents report "we don't believe in vaccinations."
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Epiglottitis is supraglottic inflammation/obstruction of the airway due to infection with Haemophilus influenzae
- Considered a medical emergency
- Caused by Haemophilus influenzae Type B bacteria (Hib)
- Kids without shots (in developed countries kids get Hib vaccine at 2, 4, 6, and 12-15 months)
- Underserved areas or nations
- Tripod or "sniffing dog" posture (neck extended)
Signs and symptoms of epiglottitis include inspiratory stridor, restlessness, cough, dyspnea, fever, and drooling
3 D’s of epiglottitis:
- Dysphagia
- Drooling
- Respiratory Distress
Diagnosis of epiglottitis, in a person who is stable and breathing comfortably, is done with a lateral neck X-ray which will classically show a thumbprint sign from swelling of the epiglottis
- A CT scan would also show a narrow airway from tissue swelling, but lying flat for a CT can obstruct the airway
- Definitive diagnosis is by laryngoscopy (in a controlled clinical setting like the OR)
- The endoscopic appearance of edematous or "cherry red" epiglottis is indicative of epiglottitis
Thumbprint Sign
Airway management first and foremost
- Individuals are often given extra oxygen, and in severe cases, may need tracheal intubation
- If tracheal intubation isn’t possible, a needle or surgical cricothyroidotomy may be needed
- Once the airway is stable, antibiotics ceftriaxone (Rocephin) to treat the infection, and intravenous steroids to decrease the swelling from the immune response
- Immunization against H. influenza type b
- May treat as an outpatient if there is no concern about the airway, otherwise, admit
 Osmosis |
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Epiglottitis is supraglottic inflammation/obstruction of the airway due to infection with Haemophilus influenzae. The Hib vaccine is available to protect against Haemophilus influenzae type b and should be given to infants in three to four divided doses starting at the age of two months. Signs and symptoms of epiglottitis include inspiratory stridor, restlessness, cough, dyspnea, fever, and drooling. It is important to note that the throat should not be examined if epiglottitis is suspected, as this could cause spasm and complete closure of the airway. Assessment of the throat should only be done when immediate endotracheal intubation is possible. Epiglottitis requires emergency treatment.
Play Video + QuizEpiglottitis Interventions
Epiglottitis is supraglottic inflammation/obstruction of the airway due to infection with Haemophilus influenzae. It is important to note that the throat should not be examined if epiglottitis is suspected, as this could cause spasm and complete closure of the airway. Assessment of the throat should only be done when immediate endotracheal intubation is possible. Epiglottitis requires emergency medical treatment.
Haemophilus influenzae
Haemophilus influenzae is a gram-negative coccobacillus that can cause several diseases, including meningitis, pneumonia, otitis media, and epiglottitis. Most strains of H. influenzae live in their host without causing disease, and only cause problems when the host has reduced immune function or inflammation in the area. Naturally acquired disease can occur in infants and young children. Type b Haemophilus influenzae can cause pneumonia and bacterial meningitis. It can also cause otitis media and epiglottitis. In fact, this organism is the most common etiologic agent associated with epiglottitis, which has a thumbprint sign seen on X-ray. Ceftriaxone antibiotic is commonly used for treatment in severe cases.
Play Video + QuizQuestion 1 |
Croupy cough and drooling | |
Thick gray, adherent exudate Hint: Thick gray adherent exudate is suggestive of diphtheria. | |
Beefy red uvula, palatal petechiae, white exudate Hint: Beefy red uvula, palatal petechiae, and white exudate are findings suggestive of streptococcal pharyngitis. | |
Inflammation and medial protrusion of one tonsil Hint: Inflammation with medial protrusion of the tonsil is suggestive of a peritonsillar abscess. |
Question 2 |
Angioedema Hint: Angioedema would present with swelling of the mouth and upper airway. Patient would not have fever or inspiratory retractions. | |
Foreign body aspiration Hint: Patients with foreign body aspiration are unlikely to appear acutely ill or be febrile. | |
Epiglottitis | |
Bacterial pharyngitis Hint: Bacterial pharyngitis is not associated with stridor or inspiratory retractions. |
Question 3 |
Administer ceftriaxone (Rocephin) Hint: See B for explanation. | |
Emergent transfer | |
Administer racemic epinephrine Hint: See B for explanation. | |
Obtain intravenous access Hint: See B for explanation. |
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References: Merck Manual · UpToDate
