- Acute epiglottitis is a medical emergency caused by bacterial infection, usually by Hemophilus influenza type b. It involves acute inflammation of the epiglottis that can lead to airway obstruction. Prompt diagnosis and securing the airway is important.
- Clinical features include high fever, sore throat, difficulty swallowing leading to drooling, and respiratory distress. Examination of the throat is not recommended due to risk of complete airway obstruction. Diagnosis is often made based on symptoms and lateral neck x-ray may show the "thumb sign".
- Management involves securing the airway with endotracheal tube or tracheostomy, IV antibiotics, and ICU care.
3. EPIGLOTTITIS
• Acute epiglottitis :acute, rapidly progressive
cellulitis of the epiglottis, aryepiglottic folds
and arytenoid soft tissue →airway
obstruction
• much more common before the widespread
use of H. influenzae type b (Hib) vaccine
• a medical emergency
• Prompt diagnosis and airway protection are
of utmost importance
5. ACUTE EPIGLOTTITIS
• Peak incidence at ~3.5 years of age (2-
5yrs)
• occurs mostly in winters
• MALE affected more
• Bacterial infection
(Hemophilus influenza type b)
8. ACUTE EPIGLOTTITIS
CLINICAL FEATURES
• more acutely in young children than in
adolescents or adults
• On presentation, most children have had
symptoms for <24 h, including
– high fever
– severe sore throat
– Laboured breathing
– difficult swallowing→ drooling
• Symptoms and signs of respiratory obstruction
may progress rapidly
9. ACUTE EPIGLOTTITIS
CLINICAL FEATURES
– systemic toxicity
– Muffled voice- “hot potato voice”
– rapidly progressing respiratory obstruction
– laboured breathing,
– hyperextended neck
– TRIPOD POSITION (sitting upright and leaning forward)
– difficult swallowing,→ drooling
– tachycardia
– CYANOSIS → COMA → DEATH
– STRIDOR -- late finding
– retractions of the chest wall
TRIPOD POSITION
10.
11. EXAMINATION
• DO NOT EXAMINE THE THROAT
Direct visualization in an examination room (e.g., with a tongue
blade and indirect laryngoscopy) is not recommended
• ASSESSMENT OF SEVERITY
– DEGREE OF STRIDOR
– RESP RATE
– H.R
– LEVEL OF CONSCIOUSNESS
– PULSE OXIMETRY
12. ACUTE EPIGLOTTITIS
DIAGNOSIS: often made on clinical
grounds
• Direct Fiberoptic Laryngoscopy is frequently
performed in a controlled environment- in OT
“CHERRY RED”APPEARANCE OF
EPIGLOTTIS
14. MANAGEMENT (ACUTE
EPIGLOTTITIS)• need to be managed in ICU
• Security of the airway with ETT or Tracheostomy
• help from Anaesthetist and ENT surgeon
• BLOOD CULTURES
• Fluid And Electrolyte Support
• I.V CEFTRIAXONE 100 mg/kg/day
• OTHER OPTIONS
– (CEFUROXIME OR CEFOTAXIME)
– CHOLRAMPHENICOL 50-75 mg/kg/day IV
• TOTAL TREATMENT :-7-10 DAYS
• RIFAMPICIN PROPHYLAXIS (for 4 days) TO CLOSE
CONTACTS
16. Complications
• In some cases, an infection can spread
from the epiglottis to nearby parts of the
body:
• Otitis media
• Meningitis
• Pericarditis
• Pneumonia
18. ACUTE LTB (VIRAL CROUP)
• viral respiratory illnesses
• characterized by marked swelling
mucosal inflammation of the glottic and
subglottic regionsof the larynx
• Etiology
– PARAINFLUENZA(1, 2, 3)
– INFLUENZA (TYPE A)
– RSV
• AGE :- 6 months – 6 years (usually <4yrs)
19. ALTB - CLINICAL FEATURES
HISTORY
• Initial :-
– Rhinorrhea
– mild cough
– fever(low grade)
• LATER (24-48 HOURS)
• Brassy (BARKING) cough
• HOARSENESS OF VOICE
• NOISY BREATHING (MAINLY ON INSPIRATION)
• Symptoms worsen at night and on lying down
• Children prefer to be held upright or sit in bed
• Symptoms resolve within a week
20. ALTB - CLINICAL FEATURES
• CLINICAL EXAMINATION
– Hoarse voice
– Normal to moderately inflammed pharynx
– slightly increased resp rate
– Prolonged inspiration and inspiratory
stridor
24. Hospitalization- indications
• Progressive stridor
• Severe stridor at rest
• Respiratory distress
• Hypoxia
• Cyanosis
• Depressed mental status
• Poor oral intake
• For reliable observation
24
25. TREATMENT of ALTB
– Moist or Humidified Air
– STEROIDS
• REDUCE THE SEVERITY AND DURATION / NEED
FOR ENDOTRACHEAL INTUBATION
• Single dose Dexamethasone 0.6mg/kg
• PREDNISOLONE PO 2mg/kg/day FOR 3 DAYS
• NEBULIZED BUDESONIDE 2mg STAT
– NEBULIZED ADRENALINE (EPINEPHRINE)-
– 2.25% racemic epinephrine in 3 ml normal saline
– epinephrine (5 mL of 1:1,000 solution) is equally
effective
29. Croup Epiglottitis
Incidence Common Rare
TIME COURSE Days Hours
Aetiology Viral Bacterial
Speed of onset Slow Very rapid
PRODROME Coryza None
Fever >38C <39C
FEEDING Can drink No
MOUTH Closed Drooling saliva
30. Croup Epiglottitis
TOXIC No Yes
Cough Brassy (Barking( Suppressed
Voice Hoarse Muffled
STRIDOR Rasping Soft
Position Supine TRIPOD SIGN (Sitting
forward, neck extended(
Neck X-Ray AP Steeple sign Normal
Neck X-Ray Lat Normal Thumb print
Response to
adrenaline
Very good No response
Severe forms of laryngotracheobronchitis that require intubation in a high proportion of patients have been reported during severe measles and infuenza A virus epidemics
Bacterial trechitis associated with S. aureus or S. pyogenes, toxic shock syndrome can develop