Acute Epiglottis

1. H. influenzae

   Annotations:

   • Unvaccinated populations
2. Streptococcal sp.
3. S. aureus
4. Cocaine

1. Laryngoscopy
2. Thumb Print Signs

   Annotations:

   • Soft tissue lateral cervical radiographs: thumb or thumbprint sign (swollen, enlarged epiglottis)

1. Unvaccinated
2. Cocaine use
3. Diabetics

Annotations:

• Odynophagia out of proportion to apparently minimal oropharyngeal findings or rapidly developing sore throat

1. The 3 D's
   1. Dysphagia
   2. Drooling
   3. Distress
2. Ondynophagia

   Annotations:

   • Fever, inspiratory stridor, dyspnea, hoarseness, muffled “hot potato” voice, tripoding
3. Cherry Red Epiglottis

   Annotations:

   • Swollen

1. Maintain Clear Airway

   Annotations:

   • Keep the patient calm Continuous monitoring of O2 saturation
2. Dexamethasone

   Annotations:

   • For airway edema
3. Hospitalization with IV Abx

   Annotations:

   • Hospitalization with IV abx  - Second or third gen cephalosporin - Penicillin, ampicillin, or anti-staphylococcal coverage may be added
4. Corticosteroids

   Annotations:

   • tapper use as signs and symptoms resolve
5. Indication to Intubate

   Annotations:

   • Dyspnea, rapid pace of sore throat where airway may close before effects of abx or corticosteroids kick in, endolaryngeal abscess on CT
6. 10 day course of abx may be appropriate

1. Rifampin given to all close contacts
2. Hib Vaccine

1. Adults

   Annotations:

   • Prognosis of adults with acute epiglottitis is good with appropriate and timely treatment. Most pts can be extubated within several days.
   • Unrecognized epiglottitis may rapidly lead to airway compromise and resultant death

Annotations:

• Meningitis, epiglottic abscess, cervical adenitis, vocal granuloma, subsequent necrotizing fasciitis of the head and neck (rare), cartilaginous metaplasia of the epiglottis, pna, pulmonary edema, empyema, ptx, pneumomediastinum (rare), pericarditits, septic arthritis, cellulitis, septic shock, death (via asphyxiation)