Infant with fever, sore throat and loss of voice (58/1700)

A 16m child presents with drooling, sore throat and loss of voice. He has fever with a temp of
38.2C. What is your next step towards management?

a. Direct pharynoscopy
b. Call ENT surgeon
c. Call anesthesiologist
d. IV fuilds
e. Start antibiotics
























ANSWER:C

ACUTE EPIGLOTTITIS
Etiology
• H. influenzae type b
• relatively uncommon condition due to Hib vaccine

Clinical Features
• any age, most commonly 1-4 yr
• rapid onset
• toxic-looking, fever, anorexia, restlessness
• cyanotic/pale, inspiratory stridor, slow breathing, lungs clear with decreased air entry
• prefers sitting up ("tripod" posture), open mouth, drooling, tongue protruding, sore throat,
dysphagia

Investigations and Management
• investigations and physical exam may lead to complete obstruction, thus preparations for
intubation or tracheotomy must be made prior to any manipulation
• stat ENT/anesthesia consult(s)
• WBC (elevated), blood and pharyngeal cultures after intubation
• lateral neck radiograph (only done if patient stable)

Treatment
• secure airway
• IV access with hydration
• antibiotics: IV cefuroxime, cefotaxime, or ceftriaxone
• moist air
• extubate when leak around tube occurs and afebrile
• watch for meningitis

When managing epiglottitis, it is
important not to agitate the child, as this
may precipitate complete obstruction
Thumb sign: cherry-shaped epiglottic
swelling seen on lateral neck radiograph