التهاب لسان المزمار

Definition

Epiglottitis is bacterial infection causing rapid swelling of the epiglottis that can obstruct the airway within hours.

Cause

Historically Haemophilus influenzae type b; much rarer since Hib vaccination, and now also caused by other organisms and seen in adults.

Symptoms (the four Ds)

• Drooling
• Dysphagia
• Dysphonia (muffled voice)
• Distress with tripod positioning
• High fever, abrupt onset, usually no cough

What to avoid

• Do not examine the throat with a tongue depressor
• Do not lay the child down or take distressing samples before the airway is secured

Treatment

• Secure the airway in theatre or a controlled setting with the most skilled team
• IV antibiotics after the airway is safe
• Oxygen given without distressing the child

Nursing care

• Keep the child calm on a parent’s lap in his position of comfort
• Intubation and tracheostomy equipment at the bedside

Exam point

Croup is gradual with a barking cough; epiglottitis is sudden with drooling and high fever.