Epiglottitis

Causes

• Group A beta hemolytic Streptococcus (Streptococcus Pyogenes)
• Streptococcus Pneumoniae
• Staphylococcus aureus
• Moraxella catarrhalis
• HaemophilusInfluenzae type B
• Previously most common cause of Epiglottitis in children
• No longer a common cause in due to Hib Vaccine
• More common in adults than children now with waning Vaccination/Immunity and failed Herd Immunity

Risks – not immunised HiB

DDx – coup, peritonsillar abscess, retropharyngeal abscess, bacterial tracheitis, airway foreign body, mononucleosis

Clinical

• Classic 4D presentation 
  • Dysphagia
  • Dysphonia
  • Drooling
  • Dyspnea
• Stridor – “Look worse then they sound” (opposite of Croup)
• Soft muffled voice (“hot potato” voice), Dysphonia or Hoarseness (31%)
• fever
• History of sore throat
• Malodorous breath
• Not coughing 
• Tripod/sniffing position
• Rapidly develop symptoms
• Differentiate from Croup)
  • Absence of cough
  • Dysphagia (Difficult Swallowing with Drooling)
  • Toxic appearance
  • Classically sitting forward with scared expression in tripod position

Treatment

• Urgent transfer ED
• Consider CT Neck for adults with suspected epiglottitis or Lateral Neck Xray –  Thumb shaped epiglottis 
• Keep calm, sitting position
• Supplementar oxygen 100% oxygen via non rebreather
• Defer invasive examinations/procedures until have ENT/anaesthetics support
• Ceftriaxone 50mg/kg