REBEL Core Cast 11.0 – Epiglottitis

Take Home Points on Epiglottitis

Epiglottitis has demonstrated a resurgence in the adult population. It is no longer a pediatric only disease.

The classic presentation of epiglottitis (3Ds of drooling, dysphagia and distress) is uncommon

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

Be ready for a difficult airway

REBEL Core Cast 11.0 – Epiglottitis

Definition: Acute infection and inflammation of the supraglottic soft tissue structures which can lead to airway occlusion. Develops over 2-7 days and is considered an ENT emergency.

Epidemiology:

Incidence of 3 – 5:100,000 per year. Mortality between 7-20%.

Mean age of those affected is 55. Child:adult ratio of 0.3:1 (due to vaccines)

Risk factors include smoking, diabetes, immunocompromised.

Broad range of causative organisms, but most commonly caused by various strep and staph species.

Traditionally taught as a children’s disorder caused by Haemophilus influenzae type B with the 3 D’s, drooling, dysphagia and distress. However due to life saving vaccines we went from a child:adult ratio of 2.6:1 to 0.3:1. ( Shah 2010

Diagnosis

Can be difficult to diagnose and some studies say that it is missed as often as 80% of the time. Initial presentation may mimic symptoms of your garden variety URI or strep throat. Think about this disease when patient presents to the ER for a second time for worsening sore throat, pain to palpation of neck, dysphagia and hoarseness.

Fiberoptic nasal layngoscopy Gold standard diagnostic test

Lateral neck xray 90% sensitivity Classic finding of “thumbprint” sign due to epiglottis thickened with inflammation

CT scan Equally as sensitive as lateral neck x-ray. May be useful if diagnosis unclear.



Airway Management

Refrain from using supraglottic devices as it could compress swollen epiglottis

Fiberoptic awake intubation may be ideal if you have necessary equipment and skill set

Consult ENT, surgery, anesthesia early to help with airway if needed

Adjunct Treatment

Ampicillin-sulbactam or Amoxicillin-clavulanate are the preferred initial antibiotic recommendations

recommendations Vancomycin for patients that are critically ill and suspicion for MRSA infection

NSAID/Corticosteroids for pain control and inflammation

Disposition

Consider admission for observation though not always necessary

If advanced inflammation or respiratory symptoms should go to ICU

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Show Notes Written By: Miguel Reyes, MD (Twitter: @Miguel_ReyesMD) Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)