Acute Epiglottis

1. H. influenzae

   Anotações:

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

1. Laryngoscopy
2. Thumb Print Signs

   Anotações:

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

1. Unvaccinated
2. Cocaine use
3. Diabetics

Anotações:

• 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

   Anotações:

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

   Anotações:

   • Swollen

1. Maintain Clear Airway

   Anotações:

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

   Anotações:

   • For airway edema
3. Hospitalization with IV Abx

   Anotações:

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

   Anotações:

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

   Anotações:

   • 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

   Anotações:

   • 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

Anotações:

• 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)