Epiglottitis
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J05.1 DESCRIPTION Life-threatening upper airway obstruction at the level of the supraglottic structures (epiglottis and arytenoids). The condition is rare since H. influenzae Type b vaccination has been introduced. DIAGNOSTIC CRITERIA Acute onset, high fever, sore throat, dysphagia,
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: J05.1
DESCRIPTION
Life-threatening upper airway obstruction at the level of the supraglottic structures (epiglottis and arytenoids). The condition is rare since H. influenzae Type b vaccination has been introduced.
DIAGNOSTIC CRITERIA
- Acute onset, high fever, sore throat, dysphagia, refusal to eat or swallow, drooling and muffled voice.
- Position of comfort to protect the upper airway: sitting upright, head forward, open mouth, neck in extension.
GENERAL AND SUPPORTIVE MEASURES
- Do not interfere with the protective mechanism of the patient. Allow the child to remain sitting up.
- Avoid all measures that could agitate the patient:
- make no attempt to see the epiglottis,
- do not routinely perform X-rays of neck and chest.
- Secure airway before IV line insertion and blood sampling.
- Monitor oxygen saturation (pulse oximeter).
Acute airway obstruction
Caution:
Epiglottitis is an upper airway emergency.
Total upper airway obstruction is imminent by the time stridor appears.
Prepare equipment for bag-mask ventilation, endotracheal intubation, needle cricothyroidotomy and tracheostomy.
- If airway obstructs completely or respiratory arrest occurs, attempt to establish an airway: ventilate with bag and mask.
- If unable to ventilate: intubate.
- If unable to intubate: perform needle or surgical cricothyroidotomy.
Total airway obstruction may occur suddenly and quite unpredictably; the patient should ideally be intubated before referral. Intubation should preferably be performed under general anaesthesia in an operating theatre.
If intubation prior to referral is not possible, transfer patient as an emergency advising transfer staff to avoid lying the child down. Inform the receiving hospital before departure.
During transport, if the child decompensates, attempt bag and mask ventilation.
After an open airway has been secured:
- take blood for cultures,
- swab epiglottis for microscopy, culture and sensitivity,
- monitor heart rate, respiratory rate, blood pressure and SaO2,
- ensure adequate nutrition and hydration.
MEDICINE TREATMENT
- Oxygen, humidified, if needed.
- Ceftriaxone, IV, 50 mg/kg/dose, once daily for 7 days.
REFERRAL
- All, once airway is secured.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 15: Respiratory System, 15.5 Upper Airway Diseases, 15.5.1 Epiglottitis