Clinical findings |
Fever and stridor with marked retractions, tachypnea, and labored breathing |
Anxious, restless, and/or toxic appearance |
Refusing to lie down, "sniffing" or "tripod" posture |
Muffled, "hot potato" voice or aphonia |
Severe sore throat with normal posterior pharynx |
Anterior neck pain at the level of the hyoid |
Unimmunized or incompletely immunized patient |
Immediate airway management |
Preparation and airway assessment
|
Sudden deterioration with complete airway obstruction
|
Airway maintained
|
After airway is secured |
Obtain surface cultures from the epiglottis |
Obtain blood cultures |
Administer IV antimicrobial therapy (refer to UpToDate content on management of epiglottitis) |
IV: intravenous; RSI: rapid sequence intubation.
* Needle cricothyroidotomy may be performed on children of any age. The pediatric age at which one can safely perform a surgical cricothyrotomy on a child is not well established, and recommendations vary from 5 to 12 years old. Surgical cricothyrotomy is best performed in children in whom external landmarks of the neck (eg, the cricothyroid membrane) are easily palpable. Refer to UpToDate topics on needle cricothyroidotomy with percutaneous transtracheal ventilation and emergency surgical cricothyroidotomy (cricothyrotomy). Do not attempt placement of a supraglottic airway device (eg, laryngeal mask airway) because these devices are not effective in patients with acute upper airway obstruction or distorted airway anatomy.
¶ Refer to UpToDate content on management of acute epiglottitis and management of the failed airway.
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