HWN Suggests

Epiglottitis

Due to the success of the Hib vaccine in decreasing the incidence of pediatric illness, epiglottitis now mainly affects adults, and its initial presentation is usually more subacute.

Epiglottitis is difficult to diagnose, and some studies have estimated that it is missed on initial presentation as much as 80% of the time. The initial symptoms of epiglottitis may be identical to a viral URI or strep throat, but can progress to airway compromise over a relatively short period of time. Adding to the difficulty in diagnosis, most patients have no external swelling or erythema. The oropharynx appears normal, since the affected area is out of view in the supraglottic space.

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Articles of Interest

EM@3AM – Epiglottitis

Toxic with signs of airway compromise: ENT consult => awake, fiberoptic intubation preferred (cricothyrotomy second line).

Epiglottitis/Supraglottitis

While many cases present early and can be managed with IV antibiotics, steroids, and close airway monitoring, delayed presentation in adults or children may require emergent intubation or a surgical airway.

Intubating a Patient with Epiglottitis

Before starting efforts at intubating any airway with laryngeal pathology, it must be appreciated by all caring for the patient that rescue ventilation may not work if the epiglottis or larynx is swollen or distorted. This applies to the LMA, King LT, and mask ventilation.

Adult epiglottitis: an under‐recognized, life‐threatening condition

In summary, a belief that epiglottitis is rare in adults has contributed to misdiagnosis and high mortality rates. We present three cases that are typical of adult epiglottitis, in that there is no one identifiable causal agent or factor that would allow rationalisation of a particular therapy. To advocate conservative management belies the aggressive nature of this disease. We believe there should be a greater emphasis on early interventional support of the airway.

Adult Epiglottitis: Not just a hot potato

The role of airway intervention in adults is controversial and a more conservative approach is recommended (antibiotics, corticosteroids, and humidified oxygen). Some studies suggest basing the decision on patient’s clinical signs and symptom.

An epiglottitis podcast

The epiglottis is the toilet seat of the airway. That’s a useful function. But what if becomes so swollen and inflamed that it leads to airway obstruction and respiratory failure. That’s bad. That’s also what epiglottitis is. You can also call it supraglottitis. Either way you need to recognize this potentially life threatening malady and secure a definitive airway in the sickest patients ASAP.

Epiglottitis & Supraglottitis

Stridor is a late sign - do not discount patients who are not stridulous. Act on clinical suspicion based on the history. Once stridor develops, you may only have minutes to act.

Epiglottitis: It Hasn’t Gone Away

While bacterial epiglottitis used to be a common disease, usually seen by pediatric anesthesiologists, it is now much less common. Here, we will discuss the pathophysiology and the infectious nature of the disease in both adults and children and will summarize anesthesia management.

Epiglottitis: Old Problem, New Patients

Successful treatment requires an early recognition of epiglottitis in adults. Up to 67% of adults could be misdiagnosed on their initial visit and may not receive appropriate therapy. Unlike in children, where the standard of practice is to intubate and protect the airway immediately regardless of the clinical condition; this approach is more controversial in adults.

More Than a Sore Throat: Acute Epiglottitis

The epidemiology of epiglottitis has changed significantly in the past several decades due to the introduction of the vaccination and widespread immunization of children against Haemophilus influenza type B (HIB). Although cases of pediatric acute epiglottitis have decreased, they have not disappeared. Furthermore, cases of acute epiglottitis in adults continue to persist as many have not been vaccinated against HIB and the causative agents in adults are much more diverse, with Streptococcus pneumoniae contributing to a majority of identified adult cases.

REBEL Core Cast 69.0 – Epiglottitis

Epiglottitis should be high on your differential for the bounce-back patient who continues to complain of worsening sore throat. Definitive diagnosis is made by flexible fiberoptic laryngoscopy.

This is the protocol for Epiglottitis

In cases of epiglottitis, we have to be particularly careful not to disturb the epiglottis. Poking around with a suction tip or an endotracheal tube has the potential to further exacerbate the inflammation and take away what little airway they have left. Allowing the patient to manage his/her airway is good enough for approximately 80% of patients.

Resources

EMCrit Project

Classic presentation of epiglottitis is sore throat with unremarkable throat exam. However, epiglottitis can involve pharynx and uvula – so erythema seen on throat exam doesn't exclude epiglottitis. 90% of adults with epiglottitis don't require intubation. With aging, the epiglottis may get smaller and more rigid; meanwhile the larynx may grow larger. Overall, this makes epiglottitis less likely to obstruct the adult airway, compared to the pediatric airway.

Radiopaedia

Acute epiglottitis is potentially life threatening due to the risk of airway obstruction, particularly in children. The adult form tends to have a lower risk of airway obstruction due to the larger size of the adult airway and better tolerance of supraglottic edema.

Emergency Medicine Cases

The symptom that should raise your suspicion of epiglottitis is throat pain out of proportion to minimal/no pharyngeal findings.

Teach Me Paediatrics

Symptom duration is usually less than 12 hours and there is typically no cough. Children will appear toxic with a high-grade fever, sore throat, dehydration and may already have signs of partial airway obstruction. Stridor is a late sign.