Acute Epiglottis

1. H. influenzae

   Nota:

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

1. Laryngoscopy
2. Thumb Print Signs

   Nota:

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

1. Unvaccinated
2. Cocaine use
3. Diabetics

Nota:

• 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

   Nota:

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

   Nota:

   • Swollen

1. Maintain Clear Airway

   Nota:

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

   Nota:

   • For airway edema
3. Hospitalization with IV Abx

   Nota:

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

   Nota:

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

   Nota:

   • 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

   Nota:

   • 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

Nota:

• 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)