AM Report 4/6/17: Epiglottitis

Wheezes: “All that wheezes is not asthma, but all that wheezes is obstruction.”

Picture1

Extrathoracic Upper Airway

Nasopharynx & Oropharynx

  • Tonsillar Hypertrophy
  • Pharyngitis
  • Peritonsillar abscess
  • Retropharyngeal abscess

Larynogpharynx & Larynx

  • Epiglottis
  • Paradoxical Vocal Cord Movement
  • Vocal Cord Paralysis
  • Anaphylaxis & Laryngeal Edema
  • Post Nasal Drip
  • Benign/Malignant Tumors
  • Relapsing Polychondritis (subglottic stenosis)

Intrathoracic Upper/Lower Airways

Trachea

  • Tracheal stenosis
  • Tracheomalacia
  • Goiter

Proximal Airways

  • Foreign-body aspiration
  • Bronchitis

Distal Airways

  • Asthma
  • COPD
  • Pulmonary edema
  • Bronchiectasis

Picture2

“Thumb sign” of epiglottitis

Infectious causes of epiglottitits

Bacterial:

  • H. influenza (type B)
  • Steptococcus pneumoniae
  • Staphylococcus aureus (MRSA/MSSA)
  • B-hemolytic streptoccoci (A-G)

Viral:

  • HSV
  • VZV
  • EBV
  • Para/Influenza

Non-Infectious

  • Thermal injury
  • Foreign body

Risk Factors:

Children: incomplete/lack of immunizations; immune deficiency

Adults: comorbid condition (HTN, DM, PSA, etc.), immune deficiency

3 D’s of Epiglottitis – Drooling, Dysphagia, Distress

Presentation:

Children: respiratory distress, anxiety, posture (see below), stridor, muffled (hot potato) voice.

Tripod Posture / Sniffling Position:

Adults: sore throat/odynophagia (~90%), fever, muffled voice, drooling, stridor/respiratory distress, hoarseness

Onset:

Children: <24 hours (frequently <12 hours)

Adults: 48 hours (65%)

Treatment:

First – secure airway!

Next – empiric antibiotics (typically 3rd generation cephalosporin and MRSA coverage)

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s