Acute Epiglottitis

[dr-awale]

Acute epiglottitis is the result of localized infection of the supraglottic larynx, usually by Haemophilus influenzae. This results in swelling of the epiglottis that obstructs the laryngeal inlet.

If there is suspicion of acute epiglottitis the child should be admitted immediately because of the danger of airway obstruction. Follow the instructions under "management of epiglottitis".
In children, possible clinical features include:

patient is usually 2 to 6 years old; croup occurs in a younger child - 2 or under
unwell; grey in colour - the child looks septic
voice is muffled
if the child coughs it may sound like a "quack"
child is quiet and terrified
increasing dysphagia
drooling
stridor - of rapid onset and the child will prefer to sit upright and lean slightly forwards in an attempt to maintain the airway. The stridor may be fairly quiet.
In adults, possible clinical features include:

as above, except that the onset is usually slower; the recovery is also slower
the principal complaint may be of a severe pain that is worse on swallowing.
This condition may be fatal in either children or adults.
Acute epiglotitis is a paediatric emergency. Management and treatment is as follows.

DO NOT:

panic
alarm the parents or child
examine the child in any way - especially do not try to visualize the epiglottitis using a tongue depressor
DO:

call a senior anaesthetist, paediatrician and ENT surgeon
alert theatres or ICU; the child needs to be admitted immediately
If respiratory arrest appears to be intervening before the senior help arrives, nebulised adrenaline can be used; this buys time but does not solve the underlying problem.

Diagnostically radiology is rarely required, and delaying treatment in order to image the child is inappropriate.