ear, nose, and throat disorders
Epiglottitis
Treatment of Epiglottitis
Airway Antibiotics (eg,ceftriaxone) In children with stridor, any intervention that could be upsetting (and thus could trigger airway obstruction) should be avoided until an airway is established. In children with epiglottitis, the airway must be secured immediately. Securing the airway can be quite difficult and should, if possible, be done by experienced personnel in the operating room. An endotracheal tube is usually required until the patient has been stabilized for 24 to 48 hours (usual total intubation time is<60 hours for both children and adults). Alternatively, a tracheotomy is done. If respiratory arrest occurs before an airway is established, bag-mask ventilation may be a life-saving temporary measure. For emergency care of children with epiglottitis, each institution should have a protocol that involves critical care, otolaryngology, anesthesia, and pediatrics. Adults whose airway is severely obstructed can be endotracheally intubated during flexible fiberoptic laryngoscopy. Other adults may not require immediate intubation but should be observed for airway compromise in an intensive care unit with an intubation set and cricothyrotomy tray at the bedside. A beta-lactamase–resistant antibiotic, such asceftriaxone50 to 75 mg/kg IV once/day (maximum 2 g), should be used empirically, pending culture and sensitivity test results. Epiglottitis caused byH. influenzaetype B can be effectively prevented with theH. influenzaetype B (HiB) conjugate vaccine. 