epiglottitis
EPIGLOTTITIS
Epiglottitis is the inflammation of the epiglottis and supraglottic tissues (aryepilottic folds, arytenoid, uvula).
It is often characterized by an acute, rapidly progressing respiratory disease.
It is a medical emergency in children requiring immediate treatment and typically artificial airway placement.
H. influenzae type B is the most common etiologic agent in children.

Assessment

  • Evaluate for presence & severity of airway obstruction based on history & physical examination
    • Patients on “tripod” position are most likely suffering from severe epiglottitis & needs immediate treatment
  • Direct examination of the pharynx in patients whose signs & symptoms are highly suggestive of epiglottitis should be deferred
  • Stabilize airway prior to performing diagnostics

Laboratory Tests

Culture

  • Culture should be performed by obtaining a swab of the epiglottis during the airway stabilization
    • 60-98% reveals H influenzae type b infection
  • Blood cultures should also be obtained once airway has been established

Other Tests

  • Complete blood count may reveal leukocytosis

Imaging

Laryngoscopy

  • Visualization of the posterior pharynx is the best way to confirm the diagnosis
  • The procedure should be performed speedily in a controlled environment [eg an operating room or an intensive care unit (ICU) where intubation may be promptly performed in the event of airway obstruction]
  • Administration of an inhaled anesthetic may allow an expeditious exam of the airway but an expert in intubation should be on stand by
  • A large, cherry-red epiglottis is usually seen
    • Aryepiglottic folds & base of the tongue may also be inflamed
  • An older cooperative child may voluntarily open the mouth wide enough to permit the direct view of the inflamed epiglottis

Radiography

  • If epiglottitis is considered possible, but not probable, the patient may first undergo x-rays of the upper airway
  • The “thumb sign” which results from edema & enlargement of the epiglottis may be seen
    • Absence of the “thumb sign” does not rule out epiglottitis, but it tells the clinician that examination of the pharynx may be done w/o great danger of airway obstruction
  • Other findings indicative of epiglottitis include absence of vallecular air space, thickened aryepiglottic folds, distended hypopharynx & straightening of cervical lordosis

Ultrasonography

  • Ultrasound evaluation in older patients usually shows an “alphabet P sign” due to severely inflamed epiglottis & the hyoid bone
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