Epiglottitis - Revision history

Danbot: Strip excess bold

2026-03-22T09:31:59Z

Strip excess bold

← Revisión anterior		Revisión del 09:31 22 mar 2026
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	*Inflammation and edema of the epiglottis and supraglottic structures		*Inflammation and edema of the epiglottis and supraglottic structures
	*A '''life-threatening airway emergency''' — can progress to complete obstruction within hours		*A '''life-threatening airway emergency''' — can progress to complete obstruction within hours
	*Incidence in children has decreased dramatically since Hib vaccine; now more common in ~~'''~~adults~~'''~~<ref name="shah">Shah RK, et al. Epiglottitis in the Hemophilus influenzae type b vaccine era. ''Laryngoscope''. 2004;114(3):557-560. PMID 15091234.</ref>		*Incidence in children has decreased dramatically since Hib vaccine; now more common in adults<ref name="shah">Shah RK, et al. Epiglottitis in the Hemophilus influenzae type b vaccine era. ''Laryngoscope''. 2004;114(3):557-560. PMID 15091234.</ref>
	*Common pathogens:		*Common pathogens:
	**Children: ~~'''~~Haemophilus influenzae type b~~'''~~ (unvaccinated)		**Children: Haemophilus influenzae type b (unvaccinated)
	**Adults: Streptococcus, Staphylococcus, H. influenzae (non-typeable), polymicrobial		**Adults: Streptococcus, Staphylococcus, H. influenzae (non-typeable), polymicrobial
	*Non-infectious causes: thermal injury, caustic ingestion, foreign body, crack cocaine		*Non-infectious causes: thermal injury, caustic ingestion, foreign body, crack cocaine
Línea 11:		Línea 11:
	===Adults===		===Adults===
	*Severe sore throat (out of proportion to pharyngeal exam findings)		*Severe sore throat (out of proportion to pharyngeal exam findings)
	*~~'''~~Odynophagia~~'''~~ (pain with swallowing), dysphagia, ~~'''~~drooling~~'''~~		*Odynophagia (pain with swallowing), dysphagia, drooling
	*Muffled or "hot potato" voice		*Muffled or "hot potato" voice
	*Stridor (late finding — suggests impending obstruction)		*Stridor (late finding — suggests impending obstruction)
Línea 19:		Línea 19:
	===Children (Classic Presentation)===		===Children (Classic Presentation)===
	*Abrupt onset high fever, toxic appearance		*Abrupt onset high fever, toxic appearance
	*~~'''~~Tripod positioning~~'''~~ (sitting forward, neck extended, chin protruding)		*Tripod positioning (sitting forward, neck extended, chin protruding)
	*Drooling, stridor, refusal to swallow		*Drooling, stridor, refusal to swallow
	*Anxiety, air hunger		*Anxiety, air hunger
Línea 34:		Línea 34:

	==Evaluation==		==Evaluation==
	*~~'''~~Lateral soft tissue neck X-ray~~'''~~ (if patient is stable):		*Lateral soft tissue neck X-ray (if patient is stable):
	**~~'''~~Thumbprint sign~~'''~~ (swollen epiglottis) — ~90% sensitive in adults		**Thumbprint sign (swollen epiglottis) — ~90% sensitive in adults
	**Thickened aryepiglottic folds		**Thickened aryepiglottic folds
	*~~'''~~Flexible nasopharyngolaryngoscopy~~'''~~ (definitive diagnosis in adults; by ENT or ED)		*Flexible nasopharyngolaryngoscopy (definitive diagnosis in adults; by ENT or ED)
	*~~'''~~CT neck with contrast~~'''~~ if concern for deep space infection, abscess		*CT neck with contrast if concern for deep space infection, abscess
	*Labs: CBC, blood cultures		*Labs: CBC, blood cultures
	*'''Do NOT examine the oropharynx in a child with suspected epiglottitis''' (risk of laryngospasm)		*'''Do NOT examine the oropharynx in a child with suspected epiglottitis''' (risk of laryngospasm)
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	==Management==		==Management==
	===Airway===		===Airway===
	*~~'''~~Airway management is the top priority~~'''~~		*Airway management is the top priority
	*Keep patient in position of comfort		*Keep patient in position of comfort
	*Have surgical airway equipment immediately available ('''cricothyrotomy''' kit)		*Have surgical airway equipment immediately available ('''cricothyrotomy''' kit)
Línea 51:		Línea 51:
	*Ideally double setup: direct/video laryngoscopy + surgical airway prepared		*Ideally double setup: direct/video laryngoscopy + surgical airway prepared
	*Heliox (70:30 helium:oxygen) may temporize in partial obstruction		*Heliox (70:30 helium:oxygen) may temporize in partial obstruction
	*~~'''~~Nebulized epinephrine~~'''~~ (racemic 2.25% 0.5 mL or L-epinephrine 1:1000 5 mL) for stridor		*Nebulized epinephrine (racemic 2.25% 0.5 mL or L-epinephrine 1:1000 5 mL) for stridor

	===Antibiotics===		===Antibiotics===
	*~~'''~~Ceftriaxone~~'''~~ 2 g IV (or Cefotaxime) PLUS		*Ceftriaxone 2 g IV (or Cefotaxime) PLUS
	*~~'''~~Vancomycin~~'''~~ if MRSA concern or critically ill<ref name="syed">Syed MI, et al. Adult epiglottitis: trends in the current era. ''Eur Arch Otorhinolaryngol''. 2012;269(10):2269-2274. PMID 22218491.</ref>		*Vancomycin if MRSA concern or critically ill<ref name="syed">Syed MI, et al. Adult epiglottitis: trends in the current era. ''Eur Arch Otorhinolaryngol''. 2012;269(10):2269-2274. PMID 22218491.</ref>
	*Alternative: Ampicillin-sulbactam 3 g IV		*Alternative: Ampicillin-sulbactam 3 g IV

	===Adjuncts===		===Adjuncts===
	*~~'''~~Dexamethasone~~'''~~ 10 mg IV (or methylprednisolone) — may reduce edema (limited evidence)		*Dexamethasone 10 mg IV (or methylprednisolone) — may reduce edema (limited evidence)
	*IV fluids (patients often dehydrated due to inability to swallow)		*IV fluids (patients often dehydrated due to inability to swallow)
	*Humidified oxygen		*Humidified oxygen

	==Disposition==		==Disposition==
	*~~'''~~Admit~~'''~~ all patients with epiglottitis		*Admit all patients with epiglottitis
	*ICU for airway monitoring, especially if stridor, drooling, or respiratory distress		*ICU for airway monitoring, especially if stridor, drooling, or respiratory distress
	*ENT consultation		*ENT consultation

Danbot: Major expansion: adult vs pediatric features, airway management, double setup, antibiotic regimens, references

2026-03-21T18:35:53Z

Major expansion: adult vs pediatric features, airway management, double setup, antibiotic regimens, references

Show changes

Danbot: Add MedicationDose SMW entries for dexamethasone, methylprednisolone, epinephrine; doses verified against ENT/EM guidelines

2026-03-20T17:43:02Z

Add MedicationDose SMW entries for dexamethasone, methylprednisolone, epinephrine; doses verified against ENT/EM guidelines

← Revisión anterior		Revisión del 17:43 20 mar 2026
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	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:ID]]		[[Category:ID]]
	[[Category:ENT]]		[[Category:ENT]
			==Medication Dosing==
			*{{MedicationDose\|drug=Dexamethasone\|dose=0.6 mg/kg\|route=PO/IM\|context=Anti-inflammatory (controversial)\|indication=Epiglottitis\|population=Adult\|notes=May reduce edema; no proven reduction in intubation rates}}
			*{{MedicationDose\|drug=Methylprednisolone\|dose=125 mg\|route=IV\|context=Anti-inflammatory (controversial)\|indication=Epiglottitis\|population=Adult\|notes=Alternative to dexamethasone}}
			*{{MedicationDose\|drug=Epinephrine\|dose=Nebulized racemic epinephrine\|route=Nebulized\|context=Reduce airway edema\|indication=Epiglottitis\|population=Adult}}

			]

Rossdonaldson1: /* Evaluation */

2024-01-17T23:06:57Z

Evaluation

← Revisión anterior		Revisión del 23:06 17 ene 2024
Línea 27:		Línea 27:

	==Evaluation==		==Evaluation==
	[[File:Compare epiglottis.jpg\|thumb\|Plain neck XR film showing normal epiglottis (left column) and enlarged epiglottitis, also known as the "~~thumb~~ sign" consistent with epiglottitis (right column).]]		[[File:Compare epiglottis.jpg\|thumb\|Plain neck XR film showing normal epiglottis (left column) and enlarged epiglottitis, also known as the "thumbprint sign" consistent with epiglottitis (right column).]]
	[[File:Epiglottitis endoscopy.jpg\|thumb\|Swollen epiglottis seen on laryngoscopy.]]		[[File:Epiglottitis endoscopy.jpg\|thumb\|Swollen epiglottis seen on laryngoscopy.]]
	*Bedside nasopharyngoscopy for direct visualization		*Bedside nasopharyngoscopy for direct visualization

Rossdonaldson1: /* Evaluation */

2024-01-17T22:52:57Z

Evaluation

← Revisión anterior		Revisión del 22:52 17 ene 2024
Línea 27:		Línea 27:

	==Evaluation==		==Evaluation==
			[[File:Compare epiglottis.jpg\|thumb\|Plain neck XR film showing normal epiglottis (left column) and enlarged epiglottitis, also known as the "thumb sign" consistent with epiglottitis (right column).]]
	[[File:Epiglottitis endoscopy.jpg\|thumb\|Swollen epiglottis seen on laryngoscopy.]]		[[File:Epiglottitis endoscopy.jpg\|thumb\|Swollen epiglottis seen on laryngoscopy.]]
	*Bedside nasopharyngoscopy for direct visualization		*Bedside nasopharyngoscopy for direct visualization

Rossdonaldson1: /* Evaluation */

2024-01-17T21:19:24Z

Evaluation

← Revisión anterior		Revisión del 21:19 17 ene 2024
Línea 27:		Línea 27:

	==Evaluation==		==Evaluation==
			[[File:Epiglottitis endoscopy.jpg\|thumb\|Swollen epiglottis seen on laryngoscopy.]]
	*Bedside nasopharyngoscopy for direct visualization		*Bedside nasopharyngoscopy for direct visualization
	*Imaging only required if diagnosis uncertain		*Imaging only required if diagnosis uncertain

Rossdonaldson1: /* Background */

2024-01-17T19:48:15Z

Background

← Revisión anterior		Revisión del 19:48 17 ene 2024
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	==Background==		==Background==
			[[File:Cross section of a trachea and esophagus.png\|thumb\|Cross section of a trachea and esophagus anatomy.]]
			[[File:Blausen 0865 TracheaAnatomy.png\|thumb\|Tracheal anatomy.]]
	*Inflammation (typically infection) of epiglottis		*Inflammation (typically infection) of epiglottis
	*Otolaryngologic emergency		*Otolaryngologic emergency

ClaireLewis at 20:54, 30 September 2019

2019-09-30T20:54:03Z

← Revisión anterior		Revisión del 20:54 30 sep 2019
Línea 1:		Línea 1:
	==Background==		==Background==
	*Inflammation(typically infection) of epiglottis		*Inflammation (typically infection) of epiglottis
	*Otolaryngologic emergency		*Otolaryngologic emergency
	**Can lead to rapid onset of life-threatening airway obstruction		**Can lead to rapid onset of life-threatening airway obstruction
Línea 12:		Línea 12:
	*Three D's:		*Three D's:
	**Drooling		**Drooling
	**Dysphagia		**[[Dysphagia]]
	**Distress		**[[respiratory distress\|Distress]]
	*Pain with gentle palpation of larynx and upper trachea		*Pain with gentle palpation of larynx and upper trachea
	*Stridor		*[[Stridor]]
	*Respiratory distress		*[[Respiratory distress]]
	*Often no cough seen or noted		*Often no cough seen or noted

Línea 34:		Línea 34:
	==Management==		==Management==
	*Emergent ENT consult		*Emergent ENT consult
	*O2 (humidified)		*[[O2]] (humidified)
	*IVF (hydration minimizes crusting in the airway)		*[[IVF]] (hydration minimizes crusting in the airway)
	**Avoid attempting IV access in a young child if likely to cause significant agitation and precipitate airway compromise		**Avoid attempting IV access in a young child if likely to cause significant agitation and precipitate airway compromise
	*Nebulized [[~~Epinephrine~~]] to reduce edema		*Nebulized [[epinephrine]] to reduce edema

	===Antibiotics===		===Antibiotics===
Línea 43:		Línea 43:

	===Steroids===		===Steroids===
	*[[Methylprednisolone]] 125mg IV vs dexamethasone 0.6mg/kg PO or IM		*[[Methylprednisolone]] 125mg IV vs [[dexamethasone]] 0.6mg/kg PO or IM
	**Controversial		**Controversial
	***Benefit: anti-inflammatory effect, decreases edema		***Benefit: anti-inflammatory effect, decreases edema
	***Many studies, however, have shown no reduction in the need for intubation, the duration of intubation, the duration of intensive care stay, or the duration of hospitalization after corticosteroids. <ref> http://bja.oxfordjournals.org/content/92/3/454.1.full </ref>		***Many studies, however, have shown no reduction in the need for intubation, the duration of intubation, the duration of intensive care stay, or the duration of hospitalization after corticosteroids. <ref> http://bja.oxfordjournals.org/content/92/3/454.1.full </ref>

	===Airway ~~Managment~~<ref>Katori H, Tsukuda M. Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol. Dec 2005;119(12):967-72</ref>===		===Airway Management<ref>Katori H, Tsukuda M. Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol. Dec 2005;119(12):967-72</ref>===
	*First line therapy is awake fiberoptic [[~~Intubation~~]] with patient sitting up.		*First line therapy is awake fiberoptic [[intubation]] with patient sitting up.
	*Preparation should be made for simultaneous [[Cricothyrotomy\|cricothyrotomy]] in case intubation fails		*Preparation should be made for simultaneous [[Cricothyrotomy\|cricothyrotomy]] in case intubation fails

Gheid: /* Management */

2019-06-23T17:19:17Z

Management

← Revisión anterior		Revisión del 17:19 23 jun 2019
Línea 43:		Línea 43:

	===Steroids===		===Steroids===
	*[[Methylprednisolone]] 125mg IV		*[[Methylprednisolone]] 125mg IV vs dexamethasone 0.6mg/kg PO or IM
	**Controversial		**Controversial
	***Benefit: anti-inflammatory effect, decreases edema		***Benefit: anti-inflammatory effect, decreases edema

Spenceemmett: /* Management */

2018-10-02T21:00:43Z

Management

← Revisión anterior		Revisión del 21:00 2 oct 2018
Línea 36:		Línea 36:
	*O2 (humidified)		*O2 (humidified)
	*IVF (hydration minimizes crusting in the airway)		*IVF (hydration minimizes crusting in the airway)
			**Avoid attempting IV access in a young child if likely to cause significant agitation and precipitate airway compromise
	*Nebulized [[Epinephrine]] to reduce edema		*Nebulized [[Epinephrine]] to reduce edema