Mr5 2-14

Morning Report

Chris Dado5-2-14

Supraglottitis/Epiglottitis

• Acute, rapidly progressing form of cellulitis of the epiglottis and surrounding structures

• Can result in complete airway obstruct• Most common bacterial pathogens– Hib (more in children)– GAS – S. pneumoniae, H. parainfluezae, S. aureus

(including MRSA)

Supraglottitis/EpiglottitisChildren v. Adults

• Presents more acutely in pediatric population, usually present within 24 hours with high fevers, sore throat, tachycardia, and drooling while leaning forward

• Adolescents and adults: milder, severe sore throat accompanied by dyspnea, drooling, and stridor.

Physical Exam

• Mod-severe respiratory distress • inspiratory stridor• retractions of chest wall• Oropharyngeal exam: underwhelming

Diagnosis

• Often made on clinical grounds• Laryngoscopy: “cherry red” epiglottis • Neck radiographs: Thumbprint sign• Labs: moderate leukocytosis with PMNs, BCX

often positive

Treatment

• Secure airway- usually more conservative with adults

• Iv antibiotics- Hib• Amp/sulbactam, cefuroxime, cefotaxime, or

CTX• Clinda or TMP-SMX for pt with allergies• 7-10 days of therapy

prophylaxis

• If unvaccinated child under 4 exposed in household to Hib- 4 days of rifampin