Recognition of epiglottitis
Epiglottitis, inflammation of the epiglottis, has now fortunately become rare as a result of Haemophilus influenzae type B vaccination.
Children present with a severe sore throat resulting in refusal to take food or liquids orally. If severe enough, the pain prevents swallowing own saliva and drooling is noticed. The laryngeal airway will become partially obstructed, and the child may show signs of respiratory distress. Stridor is a late sign and is a very concerning clinical feature.
The laryngeal airway is narrow, especially in children. Even if the patient looks well or appears to be coping, the airway can completely obstruct rapidly with further oedema development. Thus, epiglottitis represents a life-threatening airway emergency. Senior ENT and anaesthetics input must be sought immediately.
- Senior ENT and anaesthetics input.
- Do not formally examine the child or provoke further agitation/distress. Any potential stimulant may worsen the oedema and send the child into complete airway obstruction. This also means you should not attempt to cannulate the child to administer IV steroids or IV antibiotics, unlike in adult cases. Position the child upright to maximise the available airway.
- Nebulised adrenaline and nebulised steroids.
- The child must be taken to theatre in order to secure the airway by intubation.
- Patient is kept intubated and treated with IV antibiotics until a leak around the cuff of the endotracheal tube is observed (an indication of decreased airway swelling).