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.