Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Suspect epiglottitis → minimize agitation; prepare controlled airway.
- Start broad IV antibiotics; obtain imaging/endoscopy only when safe.
- Monitor closely; de-escalate therapy based on cultures; vaccinate contacts if indicated.
Clinical Synopsis & Reasoning
Abrupt sore throat, dysphagia, muffled voice, and drooling with normal oropharyngeal exam suggests epiglottitis. Avoid agitating the airway; secure in a controlled setting if signs of obstruction. Start IV ceftriaxone + vancomycin (coverage varies) and obtain lateral neck radiograph or fiberoptic exam when safe.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| Bedside assessment for stridor, tripod posture, drooling | Airway risk | Clinical diagnosis | Avoid tongue depressor in distress |
| Lateral neck radiograph or nasopharyngoscopy (when safe) | Diagnosis | Thumb sign, swollen epiglottis | Only after airway plan |
| Blood cultures and inflammatory markers | Etiology | H. influenzae, staph, strep | Tailor therapy |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Stridor, tripod posture, drooling | Impending airway closure | Airway in OR setting; ENT/anesthesia |
| Rapid progression in adults with diabetes | Severe course | Early broad-spectrum antibiotics |
| Abscess or failure of antibiotics | Complication | Surgical drainage |
| Immunosuppression | Atypical pathogens | Tailor therapy |
| Limited resources for airway rescue | Safety | Transfer to facility with airway expertise |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Airway control in OR with ENT/anesthesia | Definitive | Immediate | Prevent sudden obstruction | — |
| Ceftriaxone 2 g IV daily + Vancomycin | Empiric antibiotics | Hours | Cover common pathogens | Adjust to cultures |
| Dexamethasone (selected) | Adjunct | Hours | Reduce edema (controversial) | — |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- ENT/infectious disease guidance on adult epiglottitis — Link