Epiglottitis

Epiglottitis causes inflammatory swelling of the supraglottis and can progress to airway obstruction. Management should begin with early coordination among emergency medicine, otolaryngology, anesthesia, and critical care clinicians; this team-based preparation allows airway control under more controlled conditions if deterioration occurs. BMJ+1BMJEpiglottitis - Symptoms, diagnosis and treatmentPubMedMedical Management of Epiglottitis

Clinical diagnosis and airway risk assessment take precedence over laboratory testing or imaging when epiglottitis is suspected. Manipulation of the pharynx or larynx, attempts at routine examination, and procedures that distress an unstable patient can precipitate obstruction. BMJ+2BMJEpiglottitis - Symptoms, diagnosis and treatmentPubMedAcute epiglottitis: Trends, diagnosis and managementPubMedFlexible Nasopharyngoscopy - StatPearls - NCBI Bookshelf

Airway intervention in epiglottitis can be technically difficult because edema, distorted anatomy, narrowing, and secretions may make intubation unsuccessful. Both intubation and tracheostomy may be stimulating, and there is no consensus on one universally optimal adult technique; airway planning should include immediate rescue capability. Wolters Kluwer+1Wolters KluwerSpontaneous Respiration Using Intravenous... : A&A PracticebjanaesthesiaAdult epiglottitis: an under-recognized, life-threatening ...

In children, suspected epiglottitis is principally a clinical diagnosis. Do not perform routine oral examination, laryngoscopy, laboratory testing, or imaging before airway control in a child with a concerning presentation. Even IV placement, blood draws, and separating the child from a caregiver may provoke agitation and worsen obstruction. BMJ+1BMJEpiglottitis - Symptoms, diagnosis and treatmentPubMedEpiglottitis - StatPearls - NCBI Bookshelf - NIH

In adults without an immediate indication for airway control, close monitoring and flexible fiberoptic nasopharyngolaryngoscopy performed by otolaryngology or other experienced clinicians with anesthesia support can establish the diagnosis. Flexible examination is not benign: in suspected epiglottitis it should be restricted to an appropriate environment because laryngospasm and acute deterioration may occur. PubMed+2PubMedMedical Management of EpiglottitisPubMedEpiglottitis - StatPearls - NCBI Bookshelf - NIHPubMedFlexible Nasopharyngoscopy - StatPearls - NCBI Bookshelf

Visualization of an edematous, erythematous epiglottis and other swollen supraglottic structures confirms the diagnosis. Direct laryngoscopy may simultaneously permit definitive airway establishment but should be performed where an emergency surgical airway is available. BMJ+1BMJEpiglottitis - Tests | BMJ Best Practice USPubMedMedical Management of Epiglottitis

After the airway is secured when necessary, initiate broad-spectrum antibiotics. The supplied evidence supports the principle of broad-spectrum therapy but does not provide a regimen, dose, duration, organism-specific narrowing strategy, or evidence-based role for corticosteroids; these details should be verified against current local infectious diseases and airway-management guidance. Wolters KluwerWolters KluwerSpontaneous Respiration Using Intravenous... : A&A Practice

Obtain blood cultures and supraglottic or epiglottic cultures only if this can occur without patient perturbation or after airway security has been achieved. Blood cultures may be positive in approximately 25% of Haemophilus influenzae cases, but a negative result does not exclude epiglottitis. BMJ+1BMJEpiglottitis - Tests | BMJ Best Practice USPubMedEpiglottitis - StatPearls - NCBI Bookshelf - NIH

Once the airway is secure and antibiotics have been started, the illness generally resolves rapidly. Continued close airway observation remains appropriate because clinical decline may precede completion of diagnostic workup, particularly during early presentation. BMJ+1BMJEpiglottitis - Symptoms, diagnosis and treatmentWileyActive Emergency Management of Adult Acute Epiglottitis: ...

In settings with routine Haemophilus influenzae type b vaccination, epiglottitis has become very uncommon in children and is encountered relatively more often in adults. Nonetheless, it can occur at any age, including infancy, and the possibility should remain active when the airway phenotype is concerning. BMJ+1BMJEpiglottitis - Symptoms, diagnosis and treatmentScienceDirectSupraglottitis - an overview | ScienceDirect Topics

Adult airway compromise is less common than pediatric airway compromise because of larger laryngeal dimensions, but adult epiglottitis remains potentially fatal. Reported adult incidence is 1 to 4 per 100,000, with an estimated U.S. mortality of 0.9% in one cited review; these figures should not be used to down-triage an individual symptomatic patient. ScienceDirect+1ScienceDirectSupraglottitis - an overview | ScienceDirect TopicsWolters KluwerSpontaneous Respiration Using Intravenous... : A&A Practice