epiglottitis
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Etiology
- Haemophilus influenzae (most common)
- MRSA less common
Clinical manifestations
- sore throat 95%
- odynophagia 94%
- muffled voice 54%
- dyspnea is present in a minority of patients
- associated with a higher likelihood of need for endotracheal intubation
- classic 3Ds: drooling, dysphagia, & distress
- stridor
- globus sensation
- intermittent or variable fever
- mild tenderness & swelling in the anterior neck (case report)[2]
- no cervical lymphadenopathy (case report)[2]
Diagnostic procedures
- laryngoscopy
- erythema & inflammation of the epiglottis & base of tongue
- hypertrophy of the lingual tonsil (case report)[2]
Radiology
- lateral neck films have a sensitivity of 79% "thumb sign"
- CT of the neck: swelling & edema of the epiglottis, base of tongue, & the lingual tonsil (case report)[2]
Management
- hospitalization, consider ICU admission with surgical consultation
- airway management
- fiberoptic nasotracheal intubation for airway compromise if vocal cords not visualized with preparation for tracheostomy/cricothyrotomy[3]
- described as awake fiberoptic intubation[3]
- endotracheal intubation or tracheostomy rarely needed
- fiberoptic nasotracheal intubation for airway compromise if vocal cords not visualized with preparation for tracheostomy/cricothyrotomy[3]
- intravenous antibiotics
- 2nd or 3rd generation cephalosporin (ceftriaxone)[2])
- discharge with oral cefuroxime to complete additional 1 week of therapy (case report)[2]
- ampicillin sulbactam[3]
- include vancomycin if MRSA suspected[3]
- corticosteroids (uncertain benefit)
- dexamethasone to reduce risk of airway compromise[2]
- epinephrine (uncertain benefit)
- airway management
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11 19, College of Physicians, Philadelphia 1998, 2022
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Angirekula V, Multani A. Images in clinical medicine. Epiglottitis in an Adult. N Engl J Med 2015; 372:e20. April 9, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25853768 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1400061
- ↑ 3.0 3.1 3.2 3.3 3.4 NEJM Knowledge+ Otolaryngology
Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. 2020 Jun 1;67(2):90-97. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32633776 PMCID: PMC7342809 Free PMC article.