Epiglottitis Mrcme

Epiglottitis Mrcme

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  Epiglottitis General MedicineTeam 1 David Thompson, PGY-2 Harold H. Bach IV, MS - III
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  Clinical Features Bacterialcellulitis of the epiglottis (supraglottis) and/or surrounding tissue. Haemophilus influenzae type b (HiB) most likely pathogen H. parainfluenzae and streptococci are also reported. Average age of onset: 1–5 years old. Sudden onset: sore throat, fever, head forwardly extended, usually with drooling. Resps: delicate, little movement of head. May hear stridor.
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  Clinical Features Pharyngealvisualization (w/ EXTREME caution) shows a 'cherry red' epiglottis It is presumed in these patients that the original illness is a viral pharyngitis. Intubation is often required, but if needed, usually d/c’d in less than 24h. In most adults the disease is less severe and of slower onset. Early antibiotic treatment and intubation may prevent the need for tracheostomy. Steroids to reduce inflammation and avert tracheostomy- unproven but used.
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  Clinical Features Thewhite blood cell count in epiglottitis is often elevated, with an increase in the percentage of neutrophils and band forms. A culture of the epiglottis is usually positive for HIB but the result may not be available until the child is ready for discharge. Blood cultures are frequently positive for HIB in children, although there are usually fewer of these organisms per milliliter than in children with meningitis. X-Ray Lateral neck- enlarged hypopharynx and forward neck extension with “thumbprinting” of epiglottitis.
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  Epiglottitis- DDx Angioneuropathicedema of supraglottic structures Anaphylaxis C 1 -esterase deficiency Caustic ingestion Thermal burns of epiglottis infectious mononucleosis Laryngotracheitis Blunt Trauma
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  Epiglottitis - TxHiB vaccination early!!! Prior to HiB, there were roughly 20 K cases of HiB disease each year in the USA. Post-vaccine era = incidence of this disease has decreased by 95%. ABx #1 - Ceftriaxone (cefotaxime, cefuroxime) Others - Unasyn, Timentin, Zosyn, levaquin, gatifloxacin Amoxicillin should not be used due to noted resistance. Family Members, day-care workers, health-care workers exposed: Rifampin Ppx. of 300 mg q12h x 2d
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  Questions? Thanks foryour attention! General Medicine Team 1 David Thompson, PGY-2 Harold H. Bach IV, MS – III References “ Acute Epiglottitis.” Long: Principles and Practice of Pediatric Infectious Diseases, 2 nd ed. Online. Available: http://www.mdconsult.com . Accessed 30 April 2007. “ Ch. 31: Pharyngitis, Laryngitis, and Epiglottitis.” Cohen and Powderly: Infectious Diseases, 2 nd ed. Online. Available: http://www.mdconsult.com . Accessed 30 April 2007. Butt W, Shann F, Walker C, et al:  Acute epiglottitis : a different approach to management.   Crit Care Med   1988; 16:43-47.