Epiglotitis


- Fever
- Stridor
- Drooling
- Tripod Positioning
- Sore Throat
- "Thumb Sign" on XR

Background

Pathophysiology

History/Symptoms

Physical Exam

Diagnostics

Differential Diagnosis

  1. Croup
  2. Airway Foreign Body
  3. Retropharyngeal Abscess
  4. Caustic Ingestion
  5. Foreign Body Aspiration

Treatment

  1. Unobtrusively give O2 (blow-by).
  2. NPO, Pulse Ox, Allow parent to hold pt.
  3. Summon epiglotitis team ( most senior pediatrician, anesthesiologist, intensivist, & otolaryngologist)
    If UNSTABLE
    (unresponsive, cyanotic, Bradycardic):
    If STABLE
    -- Emergently Intubate w/ high suspicion w/ moderate or low suspicion
    -- Take pt to OR for laryngoscopy & intubation under general anesthesia. -- Lateral Neck X-raytd>
    After airway is secure:
    Blood cultures
    Epiglottic Cultures
    START ABx ASAP

Disposition

  1. Admission to peds ICU in all cases
  2. If transferring to higher level facility
 

Admit Orders: Epiglotitis

1. Admit to: Pediatric intensive care unit.

2. Diagnosis: Epiglottitis

3. Condition:

4. Vital Signs: Call MD if:

5. Activity:

6. Nursing: Pulse oximeter. Keep head of bed elevated, allow patient to sit; curved blade laryngoscope, tracheostomy tray and oropharyngeal tube at bedside. Respiratory isolation.

7. Diet:NPO

8. IV Fluids:

9. Special Medications:

-Oxygen, humidified, blow-by; keep sat >92%.

Antibiotics:

Cefotaxime :
children: 150-200 mg/kg/day IV/IM given in divided doses q6-8 hr;
adults: 1-2 g intravenously/intramuscularly every 6-12 hours;
Max: 12 g/day 
OR

Cefotaxime :
children: 150-200 mg/kg/day IV/IM given in divided doses q6-8 hr;
adults: 1-2 g intravenously/intramuscularly every 6-12 hours;
Max: 12 g/day
OR

Ampicillin/sulbactam (Unasyn) :
children: 100-200 mg/kg/day IV given in divided doses every 6 hours;
adults: 1.5 to 3 g IV every 6 hours;
Max: 12 g/day



Vancomycin :
children: 40 mg/kg/day IV given in divided doses every 6-8 hours;
adults: 2 g/day IV given in divided doses every 6-12 hours
--AND--
Cefotaxime :
children: 150-200 mg/kg/day IV/IM given in divided doses every 6-8 hours;
adults: 1-2 g IV/IM every 6-12 hours;
Max: 12 g/day
OR
Ceftriaxone :
children with mild to moderate infections: 50-75 mg/kg/day IV/IM given in divided doses every 12-24 hours;
children with severe infections: 80-100 mg/kg/day IV/IM given in divided doses every 12-24 hours;
adults: 1-2 g intravenously/intramuscularly given in divided doses every 12-24 hours;
Max: 4 g/day
 

10. Extras and X-rays: CXR PA and LAT, lateral neck. Otolaryngology consult

11. Labs: CBC, CBG/ABG. Blood culture and sensitivity, latex agglutination; UA, urine antigen screen.

 

 

 
ITE 2013, Q50
For which one of the following respiratory infections should antibiotic therapy be initiated immediately upon diagnosis?

A) Bronchitis
B) Epiglottitis
C) Laryngitis
D) Rhinosinusitis
E) Tracheitis