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Acute epiglottitis : summarized


Acute epiglottitis

Dr Tayyab Javed

Definition:inflammation of supraglottis.potential lethal condition
Etiology is both bacterial and viral.
Symptoms:
progressive and fulminant course of high fever,sore throat,dyspnea,respiratory obstruction and with in hours child looks toxic,difficulty in swallowing,laboured breathing,drooling of saliva
Signs:
hyperextended neck to maintain airway.
drooling.
sitting upright,leaning forward with chin up mouth open
air hunger
restlessness
cyanosis
coma
stridor
Investigations:
   a.laryngoscopy shows large cherry red swollen epiglottis.It should be performed by ENT specialists and in intensive care unit.
   b. lateral radiograph of neck shows thumb sign
   c.cultures of blood,epiglottic surface
   d. CBC, CRP/ESR
Treatment:
medical emergency
1.airway 
    a.suctioning if visible secretions
    b.child should be calmed and pacified
    c.anxiety provoking interventions should be avoided such as intravenous line placement,inspecting oral cavity,placing the child supine,phlebotomy
2.breathing
    a.chest rise
    b.respiratory rate
3. Assess circulation
4.endotracheal/nasotracheal intubation and tracheotomy
       a.this procedure should be performed in intensive care unit.
       b.prior to tracheotomy intubation and general anasthesia should be performed
        to avoid complications.
      c.endotracheal tube should be 0.5-1mm smaller than estimated age.
      d.it should be in placed until oedema and spasm have subsided. Early 
        endotracheal intubation reduces mortality in acute epiglottitis,.
      e.Post intubation protocol should be followed i-e epinephrine and dexamethsone 0.5mg/kg/dose 6-12hour prior to extubation then every 6hour for 6 doses.
5.antibiotics
      cefotaxime 100-200mg/kg/day IV TDS
                              OR
      ceftriaxone  50-100mg/kg/day IV BD
                              OR
      meropenum 60-90mg/kg/day IV TDS.
antibiotics should be continued for 10days.
6.rifampin prophylaxis
      indications..
all household members including
        a.immunocompromised i-e malnourished child,having chronic ailment like tuberculosis,malignancy ,taking steroids.
       b.child younger than 4yrs of age and incompletely immunized
       c.younger than 12mon of age and has not completed primary vaccination.
      dose..
        20mg/kg PO OD 4days max dose 600mg
Note..
 racemic epinephrine and corticosteroids are ineffective.



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