acute epiglottitis: clinical presentation & management

1. MANAGEMENT OF
ACUTE EPIGLOTTITIS
AZHAR AL SHUKRI
NEAR EAST UNIVERSITY

2. Acute epiglottitis
 Acute inflammatory condition confined to supraglottic
structures (epiglottis, aryepiglottic folds, and arytenoids)
 The main causative organism is Haemophilus Influenzae type
B.
 Clinical features:
◦ sore throat
◦ Dysphasia and drooling
◦ Odynophagia
◦ dyspnea & stridor
◦ fever ( up to 40 degree)

3. Normal
epiglottis
Swollen and red
epiglottis
Marked edema of
supraglottic structures
Airways obstruction

4. HOW DO YOU MANAGE A PATIENT
WITH ACUTE EPIGLOTTITIS ?

5. At initial presentation
 Mask ventilation followed by intubation is
often the first choice.
 Tracheotomy/ cricothyrotomy may be
performed in an emergency in patients
who cannot be safely intubated.
Secure airway + supplemental oxygen

6.  Third-generation cephalosporins are
preferred as first-line agents because of
increasing resistance to ampicillin.
 Ceftriaxone is the antibiotic of choice (DOC)
for epiglottitis.
Intravenous antibiotics

7. • Other antibiotics that can be used:
– Cefotaxime
– ampicillin/sulbactam
– Chloramphenicol
– Cefuroxime
– Vancomycin or clindamycin may be used
in penicillin-allergic patients

8.  Dexamethasone: used to reduce supraglottic
inflammation
 Used to decrease upper airway mucosal oedema
Corticosteroids
Racemic epinephrine

9.  The airway may not be ready for extubation
after 72 hours and continued, prolonged
intubation until the patient meets criteria may be
warranted.
Prolonged Intubation

10. Once stable and extubated
 Once the patient is not intubated and tolerating
orals, further antibiotics can be given to be
taken at home
 amoxicillin/clavulanate
 cefaclor
Oral antibiotics