Epiglotitis , ALTB. Final year MBBS Lecture

Epiglotitis , ALTB. Final year MBBS Lecture

1. Dr. Muhammad Sajjad Sabir
MCPS, FCPS (Paediatrics)

2. ACUTE
EPIGLOTTITIS

3. EPIGLOTTITIS
•Acute epiglottitis :acute, rapidly progressive
cellulitis of the epiglottis, aryepiglottic folds
and arytenoid soft tissue →airway
obstruction
•much more common before the widespread
use of H. influenzae type b (Hib) vaccine
•a medical emergency
•Prompt diagnosis and airway protection are
of utmost importance

4. Dr. Farzin khorvash

5. ACUTE EPIGLOTTITIS
•Peak incidence at ~3.5 years of age (2-
5yrs)
•occurs mostly in winters
•MALE affected more
•Bacterial infection
(Hemophilus influenza type b)

6. ACUTE EPIGLOTTITIS
CLINICAL FEATURES

7. Symptoms of Epiglottitis
•Fever
•Sore Throat
•Dysphagia
Drooling of saliva

8. ACUTE EPIGLOTTITIS
CLINICAL FEATURES
•more acutely in young children than in
adolescents or adults
• On presentation, most children have had
symptoms for <24 h, including
–high fever
–severe sore throat
–Laboured breathing
–difficult swallowing→ drooling
•Symptoms and signs of respiratory obstruction
may progress rapidly

9. ACUTE EPIGLOTTITIS
CLINICAL FEATURES
–systemic toxicity
–Muffled voice- “hot potato voice”
–rapidly progressing respiratory obstruction
–laboured breathing,
–hyperextended neck
–TRIPOD POSITION (sitting upright and leaning forward)
–difficult swallowing,→ drooling
–tachycardia
–CYANOSIS → COMA → DEATH
–STRIDOR -- late finding
–retractions of the chest wall
TRIPOD POSITION

11. EXAMINATION
•DO NOT EXAMINE THE THROAT
Direct visualization in an examination room (e.g., with a tongue
blade and indirect laryngoscopy) is not recommended
•ASSESSMENT OF SEVERITY
–DEGREE OF STRIDOR
–RESP RATE
–H.R
–LEVEL OF CONSCIOUSNESS
–PULSE OXIMETRY

12. ACUTE EPIGLOTTITIS
DIAGNOSIS: often made on clinical
grounds
•Direct Fiberoptic Laryngoscopy is frequently
performed in a controlled environment- in OT
“CHERRY RED”APPEARANCE OF
EPIGLOTTIS

13. THUMB SIGN
ON LATERAL NECK RADIOGRAPH

14. MANAGEMENT (ACUTE
EPIGLOTTITIS)•need to be managed in ICU
•Security of the airway with ETT or Tracheostomy
•help from Anaesthetist and ENT surgeon
•BLOOD CULTURES
•Fluid And Electrolyte Support
•I.V CEFTRIAXONE 100 mg/kg/day
•OTHER OPTIONS
–(CEFUROXIME OR CEFOTAXIME)
–CHOLRAMPHENICOL 50-75 mg/kg/day IV
•TOTAL TREATMENT :-7-10 DAYS
•RIFAMPICIN PROPHYLAXIS (for 4 days) TO CLOSE
CONTACTS

15. Differential Diagnosis:
Infectious
•Mononucleosis
•diphtheria
•Pertussis
•Croup
•Tonsillitis
•Retropharyngeal ,
Peripharyngeal and
peritonsillar abscesses,
•Tracheobronchitis
•Subglottic laryngitis
•Non-infectious
•Allergic reactions,
•angioneurotic
oedema
•foreign body
aspiration
•reflex laryngospasm
•laryngeal trauma
•hydrocarbon
aspiration,
•inhalation of toxic
fumes or superheated
steam

16. Complications
•In some  cases, an infection can spread
from the epiglottis to nearby parts of the
body:
•Otitis media
•Meningitis
•Pericarditis
•Pneumonia

17. Acute Laryngo-Tracheo-Brobchitis
ALTB
(VIRAL CROUP)

18. ACUTE LTB (VIRAL CROUP)
•viral respiratory illnesses
•characterized by marked swelling
mucosal inflammation of the glottic and
subglottic regionsof the larynx
•Etiology
–PARAINFLUENZA(1, 2, 3)
–INFLUENZA (TYPE A)
–RSV
•AGE :- 6 months – 6 years (usually <4yrs)

19. ALTB - CLINICAL FEATURES
HISTORY
•Initial :-
–Rhinorrhea
–mild cough
–fever(low grade)
•LATER (24-48 HOURS)
•Brassy (BARKING) cough
•HOARSENESS OF VOICE
•NOISY BREATHING (MAINLY ON INSPIRATION)
•Symptoms worsen at night and on lying down
•Children prefer to be held upright or sit in bed
•Symptoms resolve within a week

20. ALTB - CLINICAL FEATURES
•CLINICAL EXAMINATION
–Hoarse voice
–Normal to moderately inflammed pharynx
–slightly increased resp rate
–Prolonged inspiration and inspiratory
stridor

21. ACUTE LTB
•DIAGNOSIS
–CLINICAL DIAGNOSIS
–RADIOGRAPH NECK AP view :-
STEEPLE SIGN (UNRELIABLE)

23. X-Ray Neck AP Steeple Sign

24. Hospitalization- indications
•Progressive stridor
•Severe stridor at rest
•Respiratory distress
•Hypoxia
•Cyanosis
•Depressed mental status
•Poor oral intake
•For reliable observation
24

25. TREATMENT of ALTB
–Moist or Humidified Air
–STEROIDS
•REDUCE THE SEVERITY AND DURATION / NEED
FOR ENDOTRACHEAL INTUBATION
•Single dose Dexamethasone 0.6mg/kg
•PREDNISOLONE PO 2mg/kg/day FOR 3 DAYS
•NEBULIZED BUDESONIDE 2mg STAT
–NEBULIZED ADRENALINE (EPINEPHRINE)-
–2.25% racemic epinephrine in 3 ml normal saline
– epinephrine (5 mL of 1:1,000 solution) is equally
effective

26. Complication
15% of patient
•Otitis media
•Pneumonia
•Bacterial tracheitis
26

27. ALTB vs ACUTE EPIGLOTTITIS

28. ALTB vs ACUTE
EPIGLOTTITIS

29. CroupEpiglottitis
Incidence Common Rare
TIME COURSE Days Hours
Aetiology Viral Bacterial
Speed of onsetSlow Very rapid
PRODROME Coryza None
Fever >38C <39C
FEEDING Can drinkNo
MOUTH Closed Drooling saliva

30. Croup Epiglottitis
TOXIC No Yes
Cough Brassy (Barking( Suppressed
Voice Hoarse Muffled
STRIDOR Rasping Soft
Position Supine
TRIPOD SIGN (Sitting
forward, neck extended (
Neck X-Ray APSteeple signNormal
Neck X-Ray LatNormal Thumb print
Response to
adrenaline
Very good No response

31. Dr. Farzin khorvash

32. Dr. Farzin khorvash

33. Dr. Farzin khorvash

34. Dr. Farzin khorvash