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Morning Report
Chris Dado
5-2-14
Supraglottitis/Epiglottitis
• Acute, rapidly progressing form of cellulitis of
the epiglottis and surrounding structures
• Can result in complete airway obstruct
• Most common bacterial pathogens
– Hib (more in children)
– GAS
– S. pneumoniae, H. parainfluezae, S. aureus
(including MRSA)
Supraglottitis/Epiglottitis
Children v. Adults
• Presents more acutely in pediatric population,
usually present within 24 hours with high
fevers, sore throat, tachycardia, and drooling
while leaning forward
• Adolescents and adults: milder, severe sore
throat accompanied by dyspnea, drooling,
and stridor.
Physical Exam
• Mod-severe respiratory distress
• inspiratory stridor
• retractions of chest wall
• Oropharyngeal exam: underwhelming
Diagnosis
• Often made on clinical grounds
• Laryngoscopy: “cherry red” epiglottis
• Neck radiographs: Thumbprint sign
• Labs: moderate leukocytosis with PMNs, BCX
often positive
Treatment
• Secure airway- usually more conservative with
adults
• Iv antibiotics- Hib
• Amp/sulbactam, cefuroxime, cefotaxime, or
CTX
• Clinda or TMP-SMX for pt with allergies
• 7-10 days of therapy
prophylaxis
• If unvaccinated child under 4 exposed in
household to Hib- 4 days of rifampin
Mr5 2-14

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Mr5 2-14

  • 2.
  • 3.
  • 4. Supraglottitis/Epiglottitis • Acute, rapidly progressing form of cellulitis of the epiglottis and surrounding structures • Can result in complete airway obstruct • Most common bacterial pathogens – Hib (more in children) – GAS – S. pneumoniae, H. parainfluezae, S. aureus (including MRSA)
  • 5. Supraglottitis/Epiglottitis Children v. Adults • Presents more acutely in pediatric population, usually present within 24 hours with high fevers, sore throat, tachycardia, and drooling while leaning forward • Adolescents and adults: milder, severe sore throat accompanied by dyspnea, drooling, and stridor.
  • 6. Physical Exam • Mod-severe respiratory distress • inspiratory stridor • retractions of chest wall • Oropharyngeal exam: underwhelming
  • 7. Diagnosis • Often made on clinical grounds • Laryngoscopy: “cherry red” epiglottis • Neck radiographs: Thumbprint sign • Labs: moderate leukocytosis with PMNs, BCX often positive
  • 8.
  • 9. Treatment • Secure airway- usually more conservative with adults • Iv antibiotics- Hib • Amp/sulbactam, cefuroxime, cefotaxime, or CTX • Clinda or TMP-SMX for pt with allergies • 7-10 days of therapy
  • 10. prophylaxis • If unvaccinated child under 4 exposed in household to Hib- 4 days of rifampin