Acute epiglottitis is a bacterial infection that makes the epiglottis, the flap above the voice box, swell quickly and can block the airway. Since the Hib vaccine it is seen more in adults than in children, and it is a true airway emergency.
Key symptoms
- Severe sore throat and pain on swallowing
- Drooling or unable to swallow saliva
- Muffled, hot potato voice
- High fever and toxic look
- Stridor and trouble breathing in severe cases
What you find on exam
- Sitting up, leaning forward in the tripod position
- Throat may look normal despite severe pain
- Keep the patient calm; do not force a tongue depressor in a child
- Watch for stridor, retractions and falling oxygen
Tests
- Airway first: tests must not delay securing it
- Flexible laryngoscopy by an expert in a controlled setting
- Lateral neck X-ray: thumb sign, only if the patient is stable
- Blood cultures and throat culture after the airway is safe
Treatment basics
- Keep the patient sitting up and calm; give oxygen as tolerated
- Call anesthesia and ENT early; intubation in the operating room with surgical airway ready
- IV antibiotics such as ceftriaxone plus vancomycin
- Corticosteroids are sometimes given; ICU monitoring
- Rifampin prophylaxis for close contacts in Hib cases
Red flags
- Stridor, drooling or tripod position
- Falling oxygen saturation or exhaustion
- Rapid worsening over hours
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.