Epiglottitis, Croup, Tracheitis

epiglottitis
inflammation & cellulitis of epiglottis & adjacent supraglottic structures
medical emergency
epiglottitis
bacterial causes of epiglottitis
H flu
Strep
Staph
viral causes of epiglottitis
HSV-1, VZV
Influenza
EBV
fungal causes of epiglottitis
candidia
noninfectious causes of epiglottitis
thermal injury
FB ingestion
Caustic ingestion
Clinical Presentation of Epiglottitis
difficulty breathing
fever
rapid progression of dysphagia, drooling, anxious, restless, irritable

hot potato voice
tripod posture

late presentation of epiglottitis
hoarseness
cough
stridor
diagnosis of epiglottitis
visualizing the epiglottis
When should we not visualize the epiglottis?
mod to severe distress
What will the oral cavitiy and oropharynx look like in a patent with epiglottitis?
normal
supraglottic structures in epiglottitis
inflammation
edema
X ray diagnostic finding for epiglottitis
thumb sign
When can we do lab studies in epiglottitis patients?
when airway is secured
Adult presents with odynophagia out of proportion to the minimal oropharyngeal exam findings
suspect epiglottis
what patients are more commonly seen having epiglottitis?
diabetics
primary goal of epiglottitis management
maintain the airway
managing epiglottitis
hospitalize
IV antibiotics & steroids
inspiratory stridor
barky cough
hoarseness in 12 month old
Croup!
Croup is usually caused by
viruses!
parainfluenza type 1
anatomic hallmark of croup
narrowing of trachea in the subglottic region
clinical presentation of croup
nasal irritation/congestion
fever
hoarseness
BARKING COUGH
stridor
respiratory distress
Severity of Croup score
Westley Croup Score
mild croup score
/< 2
moderate croup score
3-7
severe croup score
>/ 8
Westley croup score assesses
level of consciousness
cyanosis
stridor
air entry
retractions
Diagnosing Croup
AP CXR steeple sign
managing croup
mild and self-limited
manage at home
managing moderate to severe croup
humidified air
IV fluids
close monitoring
nebulized epinhephrine and steroid
When should our croup patient stay in the hospital?
no improvement after 3-4 hours of close monitoring

respiratory distress

exudative bacterial infection on soft tissue of trachea
bacterial tracheitis
When does bacterial tracheitis generally occur?
first 6 years of life, fall and winter peaks
BT usually occurs in the setting of
prior airway mucosal damage
pathogen in nearly all cases of BT
staph aureus
primary BT presentation
fulminant onset
progression to acute respiratory distress < 24 hours after onset of minor symptoms
Secondary BT presentation
viral respiratory tract infection prodrome for 1-3 days prior to onset of severe symptoms
signs and symptoms to BT
fever
stridor
cough
drooling is uncommon
prefer to lie flat
hoarseness
wheezing
definitive diagnosis of BT
direct visualization of inflamed, exudative-covered trachea
suspect BT in kids who
present with acute onset of airway obstuction with viral URI

have croup with fever, look toxic and have poor response to treatment of croup

general treatment of BT
maintain airway
fluid resuscitation
antibiotics
what is diagnostic and therapeutic for our BT patients?
endoscopy
prognosis of BT
full recovery
death, anoxia if intervention delayed
prevention of BT
vaccination against
pneumococci
Hib
viruses