acute epiglottitis

acute epiglottitis

a severe, rapidly progressing bacterial infection of the upper respiratory tract that occurs in young children, primarily between 2 and 7 years of age. It is characterized by sore throat, croupy stridor, and inflamed epiglottis, which may cause sudden respiratory obstruction and possibly death. The infection is generally caused by Haemophilus influenzae, type B, although streptococci may occasionally be the causative agents. Transmission occurs via infection with airborne particles or contact with infected secretions. The diagnosis is made by bacteriological identification of H. influenzae, type B, in a specimen taken from the upper respiratory tract or in the blood. A lateral x-ray film of the neck shows an enlarged epiglottis and distension of the hypopharynx, which distinguishes the condition from croup. Direct visualization of the inflamed, cherry-red epiglottis by depression of the tongue or indirect laryngoscopy is also diagnostic but may produce total acute obstruction and should be attempted only by trained personnel with equipment to establish an airway or to provide respiratory resuscitation, if necessary. Epiglottitis caused by H. influenzae can be prevented by administration of H. influenzae type B conjugate vaccines to infants at or before the age of 2 months. Compare croup.
observations The infection is abrupt in onset, and it progresses rapidly. The first signs-sore throat, hoarseness, fever, and dysphagia-may be followed by an inability to swallow, drooling, varying degrees of dyspnea, inspiratory stridor, marked irritability and apprehension, and a tendency to sit upright and hyperextend the neck to breathe. Difficulty in breathing may progress to severe respiratory distress in minutes or hours. Suprasternal, supraclavicular, intercostal, and subcostal inspiratory retractions may be visible. The hypoxic child appears frightened and anxious; the skin color ranges from pallor to cyanosis.
interventions Establishment of an airway is urgent, either by endotracheal intubation or by tracheostomy. Humidity and oxygen are provided, and airway secretions are drained or suctioned. IV fluids are usually required, and antibiotic therapy is initiated immediately, usually with ceftriaxone, cefuroxime sodium, or ampicillin/sulbactam. Sedatives are contraindicated because of their depressant effect on the respiratory system, and antihistamines and adrenergic drugs usually have no therapeutic value. Steroids are useful.
nursing considerations The nurse may assist with intubation or tracheostomy once the diagnosis is confirmed. Intensive nursing care is required for a child with acute epiglottitis. The most acute phase of the condition passes within 24 to 48 hours, and intubation is rarely needed beyond 3 to 4 days. As the child responds to therapy, breathing becomes easier; rapid recovery usually occurs, so bed rest and quiet activity to relieve boredom become primary nursing concerns. The infection may spread, causing complications such as otitis media, pneumonia, and bronchiolitis. Complications of the tracheostomy may also develop and include infection, atelectasis, cannula occlusion, tracheal bleeding, granulation, stenosis, and delayed healing of the stoma. Also called acute epiglottiditis.
References in periodicals archive ?
Acute epiglottitis (AE) is a potentially life-threatening infection of the supraglottic structures, which can lead to sudden, fatal airway obstruction,[1] may require urgent tracheal intubation or tracheotomy.
To Silverman, what seemed like a bad sore throat turned out to be a case of acute epiglottitis, an inflammation of the flap at the back of the tongue which can block airways and cause asphyxiation in a matter of minutes.
Stanley RE, Liang TS: Acute epiglottitis in adults.
Neidich and her colleagues reviewed data from 820 patients in the Kids" Inpatient Databases for 2006 and 2009 who were treated for acute epiglottitis with and without obstruction.
Acute epiglottitis in adults: the Royal Melbourne Hospital experience.
Epidemiology and pathophysiology of acute epiglottitis
Acute epiglottitis was once more commonly a pediatric disease, but since the introduction of the Hemophilus influenzae type B vaccine in 1985, pediatric incidence has declined from 3.
Initial diagnosis was acute epiglottitis with airway obstruction and impending respiratory failure.
The study compared in-hospital mortality among patients who were admitted on a weekend with that among patients admitted on a weekday for the following three diseases: rupturec abdominal aortic aneurysm (5,454), acute epiglottitis (1,139), and pulmonary embolism (11,686).
Acute epiglottitis (AE) is a sudden killer: Without medical attention, the patient dies.
The clinical course of Seurat's illness was over a period of 1 week, and his son died 2 weeks later, which makes acute epiglottitis caused by H.
Pneumococcal bacteremia secondary to acute epiglottitis is relatively rare, and all previously reported cases occurred in immunocompromised patients.

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