Mr5 2-14

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Mr5 2-14

  1. 1. Morning Report Chris Dado 5-2-14
  2. 2. 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)
  3. 3. 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.
  4. 4. Physical Exam • Mod-severe respiratory distress • inspiratory stridor • retractions of chest wall • Oropharyngeal exam: underwhelming
  5. 5. Diagnosis • Often made on clinical grounds • Laryngoscopy: “cherry red” epiglottis • Neck radiographs: Thumbprint sign • Labs: moderate leukocytosis with PMNs, BCX often positive
  6. 6. 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
  7. 7. prophylaxis • If unvaccinated child under 4 exposed in household to Hib- 4 days of rifampin

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