Makindo Medical Notes

🚨 Acute Epiglottitis is a rapidly progressive, life-threatening infection of the supraglottic structures that can cause sudden airway obstruction. ⚠️ Emergency: Immediate involvement of senior anaesthetic + ENT specialists is essential. 🛑 Do not attempt throat examination until the airway is secured – even minimal stimulation may precipitate complete obstruction.

ℹ️ About

• 🔥 Acute epiglottitis = cellulitis & inflammation of the epiglottis & aryepiglottic folds.
• 👶 Once a classic paediatric emergency, but 📈 adult incidence has risen due to Hib vaccination in children.
• 💉 In children, Hib immunisation reduced incidence >90%.
• ⚡ Mortality: ~1–5% overall, but higher in adults due to delayed recognition.

🦠 Aetiology

• Children (unvaccinated): Haemophilus influenzae type b.
• Adults: Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Neisseria meningitidis.
• Risk factors:
  • 🚫 No Hib vaccination.
  • 🦠 Immunocompromised (HIV, chemo, steroids).
  • 🍬 Diabetes mellitus.
  • 🔥 Thermal/chemical injury (inhalation burns, caustics).
  • 💊 Immunosuppressive medication.

🩺 Clinical Presentation

• ⏱️ Rapid onset (hours) – unlike croup which is gradual.
• Classic triad in children: 🤤 Drooling + 😰 Distress + 🗣️ Dysphonia ("3 Ds").
• Key features:
  • 😖 Severe sore throat & odynophagia (disproportionate to oropharyngeal findings).
  • 🗣️ Muffled “hot potato” voice ± hoarseness.
  • 🌬️ Soft inspiratory stridor.
  • 🤤 Drooling (inability to swallow).
  • 🌡️ High fever >38.5°C + toxic appearance.
  • 🧎 Tripod position: sitting forward, chin protruded, mouth open.
  • 👶 Children often refuse to lie flat (risk of obstruction).
• Adults may present less dramatically – sore throat + dysphagia ± mild stridor → beware under-diagnosis.

🔬 Investigations (only after airway secured!)

• 🧪 FBC, CRP, blood cultures.
• 🖼️ Lateral neck X-ray: “Thumbprint sign” (swollen epiglottis). But do not delay airway intervention.
• 👁️ Fibre-optic laryngoscopy: diagnostic gold standard – only in controlled environment with airway backup.

📊 Comparison: Croup vs Bacterial Tracheitis vs Epiglottitis

🚑 Management

• Do not upset the child – avoid IV attempts, bloods, unnecessary handling.
• 💨 High-flow humidified O₂; keep upright & calm (with parent).
• 📞 Call ENT + anaesthetics + paediatrics immediately.
• Airway:
  • ✅ Intubation in theatre by senior anaesthetist with ENT standby.
  • 🔪 Surgical airway (cricothyrotomy/tracheostomy) if intubation fails.
• Medical therapy (post-airway):
  • 💊 IV ceftriaxone or cefotaxime (empiric).
  • ➕ Consider vancomycin/flucloxacillin if MRSA/S. aureus suspected.
  • 💊 Corticosteroids sometimes used to reduce oedema (evidence mixed).
  • 🧴 IV fluids & analgesia for support.
• Ongoing: ICU admission, close observation, remove ETT only when swelling resolved (usually 48–72 hrs).
• Prevention: Hib vaccination programme (key reason for reduced childhood cases).

✅ Key Pearls

• 🚨 Epiglottitis = airway emergency until proven otherwise.
• 🛑 Never use tongue depressor outside controlled theatre.
• 👶 Children: rapid deterioration likely → manage in PICU/ENT centre.
• 🧑 Adults: subtler onset → consider epiglottitis in severe sore throat with normal throat exam.
• 💉 Early Hib vaccination dramatically reduced paediatric incidence.