Epiglottitis is a rapidly progressing infection of the epiglottis and nearby tissues that can swell and block the airway. Since the Hib vaccine it is seen more in adults than in children, and the priority is protecting the airway in a calm, controlled setting.
Key symptoms
- Severe sore throat, out of proportion to the throat exam
- Painful swallowing, drooling
- Muffled voice
- Fever
- Trouble breathing, stridor in later stages
What you find on exam
- Patient sitting forward in the tripod or sniffing position
- Toxic appearance, drooling, stridor
- Throat may look nearly normal; no tongue depressor in a child in distress
- Tenderness over the larynx when moved gently
- Oxygen saturation, without upsetting the patient
Tests
- Keep a child calm with a parent; no blood draws or IV until the airway is secure
- Flexible laryngoscopy by an expert in a stable adult: swollen cherry-red epiglottis
- Lateral neck X-ray only if stable: thumb sign
- Blood and epiglottis cultures after the airway is secured
Treatment basics
- Call anesthesia and ENT; prepare for a difficult airway with surgical airway backup
- Intubation in the operating room for children and for adults in distress
- IV ceftriaxone plus vancomycin
- Humidified oxygen; keep the patient upright
- Rifampin prophylaxis for close contacts in Hib cases when indicated
Red flags
- Stridor, drooling or tripod position
- Rapid progression of symptoms over hours
- Falling oxygen saturation or exhaustion
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.