Causes of Epiglottitis

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Questions and Answers

What is the primary reason for not performing an oropharyngeal exam in suspected cases of epiglottitis?

The exam may induce laryngospasm

The patient is likely to be uncooperative

It may lead to manipulation of the oral cavity, causing respiratory arrest (correct)

It is not necessary for the diagnosis

What is the most common pathogen in both adults and children with epiglottitis?

S. aureus

S. Pneumoniae

Beta-hemolytic Streptococcus sp.

H. influenzae (correct)

What is the typical position of a child with epiglottitis in the emergency department?

Standing with support

Lying flat on their back

Kneeling

Sitting upright with the mouth open in a tripod position (correct)

What is the significance of cyanosis in patients with epiglottitis?

It is indicative of advanced infection and poor prognosis Signup and view all the answers

What is the primary method of diagnosis for epiglottitis?

Clinical suspicion based on symptoms and signs Signup and view all the answers

When should a complete blood count with differential, blood culture, and epiglottal culture be obtained?

Only in patients with a secured endotracheal tube Signup and view all the answers

What is the significance of the 'thumb sign' on a lateral neck radiograph?

It is pathognomonic for epiglottitis Signup and view all the answers

What is the typical duration of symptoms before dramatic worsening in patients with epiglottitis?

Hours to days Signup and view all the answers

Why is ultrasonography not commonly used in the evaluation of epiglottitis?

It may precipitate disaster in unstable patients Signup and view all the answers

What is the primary purpose of performing a lateral neck radiograph in suspected epiglottitis?

To narrow down the differential diagnosis Signup and view all the answers

What is the most common cause of epiglottitis in children?

Haemophilus influenzae type B (HIB) Signup and view all the answers

What is the narrowest portion of the infant and pediatric airway?

Subglottis Signup and view all the answers

What is the reason why an infectious process causes symptoms in a child more readily than in an adult?

Pliant epiglottis cartilage in children Signup and view all the answers

What is the name of the process where a prior viral infection allows bacterial superinfection to develop?

Superinfection Signup and view all the answers

What is the location of the epiglottis in a young child compared to an adult?

More superiorly and anteriorly Signup and view all the answers

What is the reason for the decrease in incidence of HIB in children?

Widespread availability of immunizations Signup and view all the answers

What type of agent is implicated in epiglottitis in patients who are immunocompromised?

Fungal Signup and view all the answers

What is the characteristic of the epiglottis cartilage in an adult compared to a child?

More rigid Signup and view all the answers

What is the primary importance of the triage nurse and emergency room physician knowing the signs and symptoms of the disorder?

To prevent respiratory distress and death Signup and view all the answers

What is the primary concern when dealing with a diagnosis of epiglottitis?

Securing the airway Signup and view all the answers

What should the nurse avoid when positioning the patient?

Placing the patient supine Signup and view all the answers

What percentage of patients with epiglottitis may have concomitant pneumonia?

10-15% Signup and view all the answers

What is the purpose of having a tracheostomy tray available at the bedside?

To perform an emergency tracheostomy Signup and view all the answers

Why should the patient never be allowed to go to a radiology suite alone and without monitoring equipment?

To ensure the patient's safety Signup and view all the answers

What is the purpose of obtaining a lateral neck X-ray in select cooperative patients?

To confirm the diagnosis of epiglottitis Signup and view all the answers

Why should corticosteroids be used in the treatment of epiglottitis?

To reduce edema and shorten ICU stay Signup and view all the answers

What should be done before probing the oral cavity?

The airway should be secured Signup and view all the answers

How long may some patients require mechanical ventilation?

For a few days Signup and view all the answers

What is the indication for extubation in patients with epiglottitis?

When a leak around the endotracheal tube can be demonstrated with the cuff deflated Signup and view all the answers

Why should non-intubated patients with epiglottitis be admitted for observation?

To monitor for signs of respiratory distress Signup and view all the answers

What is the recommended approach to prophylaxis for close contacts of patients with H.influenzae?

Prescribing rifampin prophylaxis Signup and view all the answers

What is the mortality rate reported in patients with unstable airways due to epiglottitis?

3-7% Signup and view all the answers

What is the recommended vaccination schedule for preventing epiglottitis?

According to the schedule prescribed by the WHO Signup and view all the answers

What should be available at the bedside of non-intubated patients with epiglottitis?

A tracheostomy tray Signup and view all the answers

Study Notes

Etiology

The cause of epiglottitis is most commonly infectious, with bacterial, viral, or fungal origins.
In children, Haemophilus influenzae type B (HIB) is the most common cause, but this has decreased dramatically since the widespread availability of immunizations.
Other agents such as Streptococcus pyogenes, S pneumoniae, and S aureus have been implicated.
In immunocompromised patients, Pseudomonas aeruginosa and Candida have been named.

Pathophysiology

The airway in the pediatric population is markedly different compared to that of an adult.
The epiglottis is located more superiorly and anteriorly in children, with a more oblique angle with the trachea.
The narrowest portion of the infant and pediatric airway is the subglottis, while in adults it is the glottis.
The infant epiglottis is comprised of cartilage that is more pliant, allowing for a ball-valve effect, where each inspiration pulls an edematous epiglottis over the laryngeal airway, causing symptoms.

History and Physical

The history will often reveal an antecedent URI, but not always.
Symptoms may be mild for a period of hours to days, until they dramatically worsen, mimicking a sudden onset.
The patient will appear very uncomfortable, and possibly overtly toxic.
Most children have no prodromal symptoms.
The 3 Ds - drooling, dysphagia, and distress, or anxiety - may be present.
Swelling of the upper airway results in turbulent airflow during inspiration or stridor.

Evaluation

An oropharyngeal exam is usually not performed to evaluate a suspected case of epiglottitis.
A lateral neck radiograph will show swelling of the epiglottis, also referred to as the "thumb sign".
A flexible fiberoptic laryngoscopy can be performed in a controlled setting, but only in the most stable and cooperative patients.
Ultrasonography may reveal an "alphabet P sign" in a longitudinal view.

Treatment/Management

The singular, most important aspect of treatment is to secure the airway.
Experienced providers should intubate these patients, as their airways are regarded as difficult.
The patient should be admitted to the intensive care unit after the airway is secured.
Empiric antimicrobials should be initiated, and adjusted once culture and sensitivity results are available.
Corticosteroids may be used to reduce edema.

Prognosis

For most patients with epiglottitis, the prognosis is good when the diagnosis and treatment are prompt.
When the diagnosis is delayed in children, airway compromise can occur, and death is possible.
A mortality rate of 3% to 7% has been reported in patients with unstable airways.

Prevention and Deterrence

Close contacts of patients with H.influenzae who are not immunized should be prescribed rifampin prophylaxis.
Vaccination should be encouraged to prevent epiglottitis.
Children should be immunized according to the schedule prescribed by the WHO.

Healthcare Team Outcomes

Epiglottitis is a relatively common fear in the emergency department, but actually rather rare.
The disorder should be managed by an interprofessional team that includes an intensivist, pulmonologist, infectious disease consult, anesthesiologist, and ENT surgeon.
The triage nurse and emergency room physician should be familiar with the signs and symptoms of the disorder.
Nurses should be educated about not placing the patient supine and the importance of monitoring oxygenation.

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Description

This quiz covers the various causes of epiglottitis, including infectious and noninfectious etiologies. Learn about the different bacteria, viruses, and fungi that can cause this condition.