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Epiglottitis - Causes, Symptoms and Treatment

What is Epiglottitis?

Acute epiglottitis is an inflammation of the epiglottis that tends to cause airway obstruction. It typically strikes children ages 2 to 8. A critical emergency, epiglottitis can prove fatal in 8% to 12% of victims unless it's recognized and treated promptly.

What are the Causes of Epiglottitis?

Epiglottitis usually results from infection with the bacterium Haemophilus influenzae type B, and, occasionally, pneumococci and group A streptococci.

What are the Signs and Symptoms of Epiglottitis?

Sometimes preceded by an upper respiratory tract infection, epiglottitis may progress to complete upper airway obstruction within 2 to 5 hours. Laryngeal obstruction results from inflammation and edema of the epiglottis. Accompanying symptoms include high fever, stridor, sore throat, dysphagia, irritability, restlessness, and drooling.

To relieve severe respiratory distress, the child with epiglottitis may hyperextend his neck, sit up, and lean forward with his mouth open, tongue protruding, and nostrils flaring as he tries to breathe. He may develop inspiratory retractions and bronchi.

Diagnosis for Epiglottitis

In acute epiglottitis, throat examination reveals a large, edematous, bright red epiglottis. Such examination should follow lateral neck X-rays and, generally, should not be performed if the suspected obstruction is large.

When examining the patient, have special equipment (a laryngoscope and endotracheal [ET] tubes) available because a tongue depressor can cause sudden, complete airway obstruction. Trained personnel (such as an anesthesiologist) should be on hand during throat examination to secure an emergency airway.

Treatment for Epiglottitis

ALERT A child with acute epiglottitis and airway obstruction requires emergency hospitalization; he may need emergency endotracheal intubation or a tracheotomy and should be monitored in an intensive care unit.

Respiratory distress that interferes with swallowing necessitates parenteral fluid administration to prevent dehydration.

A patient with acute epiglottitis should always receive a 10-day course of parenteral antibiotics - usually a second- or third-generation cephalosporin. (If the child is allergic to penicillin, a quinolone or sulfa drug may be substituted.) Oxygen therapy and arterial blood gas monitoring may be desirable.

Special Considerations and Prevention Tips for Epiglottitis

1. Keep the following equipment available in case of sudden, complete airway obstruction: a tracheotomy tray, ET tubes, a handheld resuscitation bag, oxygen equipment, and a laryngoscope with blades of various sizes. Monitor arterial blood gas levels for hypoxia and hypercapnia.

2. Watch for increasing restlessness, rising heart rate, fever, dyspnea, and retractions, which may indicate the need for an emergency tracheotomy.

3. After tracheotomy, anticipate the patient's needs because he won't be able to cry or call out, and provide emotional support. Reassure the patient and his family that the tracheotomy is a short-term intervention (usually from 4 to 7 days).

4. Monitor the patient for rising temperature and pulse rate and for hypotension­signs of secondary infection.

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