Acute Epiglottis

1. H. influenzae

   Anmerkungen:

   • Unvaccinated populations
2. Streptococcal sp.
3. S. aureus
4. Cocaine

1. Laryngoscopy
2. Thumb Print Signs

   Anmerkungen:

   • Soft tissue lateral cervical radiographs: thumb or thumbprint sign (swollen, enlarged epiglottis)

1. Unvaccinated
2. Cocaine use
3. Diabetics

Anmerkungen:

• Odynophagia out of proportion to apparently minimal oropharyngeal findings or rapidly developing sore throat

1. The 3 D's
   1. Dysphagia
   2. Drooling
   3. Distress
2. Ondynophagia

   Anmerkungen:

   • Fever, inspiratory stridor, dyspnea, hoarseness, muffled “hot potato” voice, tripoding
3. Cherry Red Epiglottis

   Anmerkungen:

   • Swollen

1. Maintain Clear Airway

   Anmerkungen:

   • Keep the patient calm Continuous monitoring of O2 saturation
2. Dexamethasone

   Anmerkungen:

   • For airway edema
3. Hospitalization with IV Abx

   Anmerkungen:

   • Hospitalization with IV abx  - Second or third gen cephalosporin - Penicillin, ampicillin, or anti-staphylococcal coverage may be added
4. Corticosteroids

   Anmerkungen:

   • tapper use as signs and symptoms resolve
5. Indication to Intubate

   Anmerkungen:

   • Dyspnea, rapid pace of sore throat where airway may close before effects of abx or corticosteroids kick in, endolaryngeal abscess on CT
6. 10 day course of abx may be appropriate

1. Rifampin given to all close contacts
2. Hib Vaccine

1. Adults

   Anmerkungen:

   • Prognosis of adults with acute epiglottitis is good with appropriate and timely treatment. Most pts can be extubated within several days.
   • Unrecognized epiglottitis may rapidly lead to airway compromise and resultant death

Anmerkungen:

• Meningitis, epiglottic abscess, cervical adenitis, vocal granuloma, subsequent necrotizing fasciitis of the head and neck (rare), cartilaginous metaplasia of the epiglottis, pna, pulmonary edema, empyema, ptx, pneumomediastinum (rare), pericarditits, septic arthritis, cellulitis, septic shock, death (via asphyxiation)