Question
A 5 year old boy presented with sudden onset of fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor.On X ray of neck,the following is seen.
Which is the most common cause of death in this condition ?
A. Acidosis.
B. Respiratory obstruction.
C. Atelactasis.
D. Laryngospasm.
Show Answer
Correct Answer » B
Explanation
Ans;B. Respiratory obstruction.
The condition marked by an arrow in the X-ray above represents Acute Epiglottitis.
Enlarged epiglottis in epiglottitis is stubby like thumb instead of its usual thin finger projection.(Thumb Sign)
ACUTE EPIGLOTTITS
- It is an acute inflammation of epiglottis with inflammatory edema of hypopharynx.
- H.influenzae Influenza Type B is the most common causative organism.
- Other organisms are – Pneumococci, Streptococcus pyogenes, N.meningitidis, Staphylococcus.
CLINICAL FEATURES OF EPIGLOTTITIS
- Onset is sudden
- Symptoms are fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor.
- Patients often sit in sniffing dog position.
Complications:
- The main complication is death from respiratory arrest due to acute airway obstruction.
- Other complications are rare but include epiglottic abscess, pulmonary edema secondary to relieving airway obstruction and thrombosis of internal jugular vein (Lemierre’s syndrome)
DIAGNOSIS AND TREATMENT OF EPIGLOTTITIS
- Laryngoscopy-“Cherry red” swollen epiglottis is seen.
- Acute Laryngeal Spasm may occur during Indirect Laryngoscopy.
- Radiograph – Culture of blood and secretions covering Epiglottis
- A plain lateral soft tissue radiograph of neck shows the following specific features
- Thickening of the epiglottis—the thumb sign
- Absence of a deep well-defined vallecula—the vallecula sign
Treatment
- Immediate endotracheal intubation.
- IV antibiotics to cover H.influenzae.
- The antibiotic of choice in acute epiglottitis pending culture sensitivity report is Ampicillin or 3rd generation Cephalosporin like Ceftriaxone.
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