QuestionSBA
QuestionChoice
This child has acute epiglottis, which is often caused by Haemophilus influenzae type B. Fortunately, due to vaccinations, this is becoming less common, but this child has not had all of his childhood vaccinations. He has evidence of airway obstruction, and so the immediate next step is to secure his airway. Any further delay may result in complete airway obstruction. It is important to do nothing to cause additional distress, including cannulation or further examination, since this may result in further emotional distress and sudden loss of the airway.
53172
a
Call the anaesthetists for intubation and ventilation
QuestionChoice
This is incorrect because intramuscular adrenaline is a treatment for  anaphylaxis. This is an important differential diagnosis because anaphylaxis causes shortness of breath and stridor. However, one would expect additional clinical features, such as acute onset, rash, itch, and onset after exposure to an allergic trigger. However, this patient does not have anaphylaxis, and the priority in any case in the context of apparent airway obstruction is to secure his airway.
53174
c
Intramuscular adrenaline
QuestionChoice
Oral dexamethasone is provided for children with croup, which is caused by Parainfluenza virus. Croup is an important differential diagnosis for acute epiglottitis because it can present with stridor, but the child is well and able to eat and drink (though may be off food.) Fevers are usually low-grade, and the child has a characteristic barking cough. Drooling is not a feature.
53175
d
Oral dexamethasone
QuestionChoice
This child has acute epiglottis, which is often caused by Haemophilus influenzae type B. Fortunately, due to vaccinations, this is becoming less common, but this child has not had all of his childhood vaccinations. He has evidence of airway obstruction, and so the immediate next step is to secure his airway. Any further delay may result in complete airway obstruction. It is important to do nothing to cause additional distress since this may result in sudden loss of the airway. Applying a nebuliser mask to this clearly upset, crying child who is in pain may cause further distress which can precipitate acute airway obstruction, and furthermore delay the most important next step, which is to prioritise securing the airway at this stage.
53176
e
Nebulised adrenaline
QuestionChoice
This child has acute epiglottis, which is often caused by Haemophilus influenzae type B. Fortunately, due to vaccinations, this is becoming less common, but this child has not had all of his childhood vaccinations. He has evidence of airway obstruction, and so the immediate next step is to secure his airway. Any further delay may result in complete airway obstruction. It is important to do nothing to cause additional distress, including cannulation for intravenous antibiotic administration, or further examination, since this may result in further emotional distress, airway spasm, and sudden loss of the airway. Intravenous antibiotics can be provided once the airway is secured.
53173
b
Intravenous antibiotics
QuestionComment
why can't I just intubate myself
27333
QuestionComment
If you intubate yourself there will be noone left to treat the patient
28053
User
subscriber
Metabolism Benign
QuestionComment
Yeah not appropriate really, good thing the SJT has been scrapped 
28466
User
subscriber
LolWilkesLol
User
subscriber
Intravenous Prone
Concept
Chapter
# Summary
 

Epiglottitis is inflammation of the epiglottis and surrounding tissues that can result in abrupt blockage of the upper airway and potentially death. It is most prevalent in children aged 1-6 years and is preventable through the Haemophilus influenza B (Hib) vaccine. Key signs and symptoms include high fevers, an intensely painful throat, soft inspiratory stridor, and the child maintaining an upright, open-mouth position. It's crucial to identify potential differential diagnoses such as croup, peritonsillar abscess, and bacterial tracheitis. Immediate management involves securing the airway, potentially via endotracheal intubation, followed by administration of IV antibiotics, specifically cefuroxime.
 

# Definition
 

Epiglottitis is a rapidly progressive infection that leads to inflammation of the epiglottis and adjacent tissues. This inflammation can swiftly progress to blockage of the upper airway, posing a risk of death.
 

# Epidemiology
 

Epiglottitis is most common in children aged 1-6 years, but it can occur at any age. With the widespread use of the Haemophilus influenza B (Hib) vaccine, the incidence of epiglottitis has significantly decreased, making it a rare condition, particularly in developed countries like the UK. It affects 1 in every 100,000 in the UK. 
 

# Aetiology
 

The primary aetiological agent of epiglottitis is Haemophilus influenza B (Hib).
 
Less common causes include Streptococcus pneumoniae, fungal infections and Varicella Zoster virus. 
 

# Signs and Symptoms
 

Patients with epiglottitis often present with:
 

 -  High fevers
 -  Appear ill or toxic
 -  Intense throat pain that prevents speaking or swallowing, leading to drooling
 -  Soft inspiratory stridor
 -  Rapid increase in respiratory difficulty over hours
 -  A tendency to sit upright with an open mouth to optimise airway patency
 -  Minimal or absent cough
 -  Muffled or hoarse voice 
 -  Stridor 
 

# Differential Diagnosis
 

 -  **Croup:** Characterised by a barking cough, inspiratory stridor, and hoarseness.
 -  **Peritonsillar abscess:** Presents with severe throat pain, muffled " hot potato" voice, drooling, and trismus (difficulty opening the mouth).
 -  **Bacterial tracheitis:** Severe respiratory distress, high fever, and purulent tracheal secretions can be noted.
 

# Investigations
 

Confirmatory diagnosis of epiglottitis involves direct visualisation of the inflamed epiglottis, which should only be performed by experienced clinicians due to the risk of triggering airway obstruction. This is typically done using laryngoscopy after securing the airway. 

Further investigations may include:

- Throat swab, once the airway is secure, may isolate the causative organism 
- Lateral neck X-ray may show the thumb sign: thickening of aryepiglottic folds
- CT or MRI may be required if there are concerns about abscess formation 
 

# Management
 

Epiglottitis is a medical emergency requiring prompt intervention. Management includes:
 

 -  Do not examine or upset the child without senior support
 -  Securing the airway, possibly through endotracheal intubation, is a priority
 -  Culturing and examination of the throat once the airway is secure
 -  Administration of IV antibiotics, typically cefuroxime

#  Complications 
 
 - Abscess formation
 - Bacteraemia and sepsis
 - Meningitis 
 - Pneumothorax 
 - Airway obstruction and death

#  Prognosis 
 
Early diagnosis and detection enable many children to make a complete recovery and reduce the need for intubation. 
 

# NICE Guidelines
 
 [NICE Guidance for Sore throat - acute](https://cks.nice.org.uk/topics/sore-throat-acute/management/management/) 
 
#  References
 
 [NHS Information on Epiglottitis](https://www.nhs.uk/conditions/epiglottitis/) 

 [BMJ Best Practice page on epiglottitis](https://bestpractice.bmj.com/topics/en-gb/452)
 
 [Patient Info Epiglottitis](https://patient.info/doctor/epiglottitis-pro)
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Acute Epiglottitis
Topic
29
Paediatrics
Condition
254
Epiglottitis
UkmlaTopic
5
Child health
10695
The management of acute epiglottitis involves immediate securing of the airway, often through endotracheal intubation or, in severe cases, a tracheostomy, along with administration of antibiotics to treat the underlying infection and corticosteroids to reduce inflammation.
Presentation
78
Behavioural difficulties in childhood
UkmlaTopic
5
Child health
A 3-year-old boy is brought to A&E with his mother as she is concerned he has not been eating since the morning. She says she has heard him making strange breathing noises which she cannot explain. He has not had all of his childhood vaccines, but his past medical history is otherwise unremarkable. On examination, he is sitting upright with his mouth open and drooling, and there is evidence of inspiratory stridor. He is crying out in pain and has a muffled voice when he tries to talk. He is unable to eat and drink. His vital signs show HR 160bpm, 45 breaths per minute, a systolic BP of 70mmHg, and temperature of 39.9.

Which of the following is the most appropriate next step in his  management?
a