ENT

ResponseAcute epiglottitis

Thickening of epiglottis (thumb printing sign)
Loss of cervical spine lordosis
Normal prevertebral soft tissues paces
No visible FB

ResponseHaemophilus influenzae B (HiB)
Haemophilus parainfluenzae
Strep pneumoniae (most common now vaccinations for HiB)
Group A strep (pyogenes)
S. Aureus
Atypical (Mycoplasma)

ResponseNurse in position of best comfort, avoid distressing child
Call for urgent assistance from anaesthetics/ENT
Prepare to manage airway obstruction (Difficult airway equipment including cric kit. Aim to intubate in OT with awake intubation unless acute deterioration)
Analgesia - IV paracetamol 1g, morphine 0.1g/kg titrated to analgesia but not drowsiness
Antibiotics

• Ceftriaxone 50mg/kg to 2g (RCH + etG)
• Moxifloxacin 400 mg IV if penicillin allergy

Dexamethasone 10 mg commonly given, minimal evidence
eTG May ‘24

ResponseIf time and resources allow - awake fibreoptic in theatre with ENT backup
Positioning - unable to lie flat - preoxygenate in upright position
Laryngoscopy - large epiglottis likely to distort view - use of straight (miller) blade, hypercurved blade may improve view
Tube delivery - Laryngeal inlet may be narrowed or soiled with pus - use of narrow bore ETT or bougie
Failed airway plan - unlikely to be able to ventilate through LMA - have equipment and landmarks ready for surgical cricothyroidotomy