Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Keep patient upright and calm; avoid manipulating airway outside controlled setting.
- Call ENT/anesthesia; prepare for awake fiberoptic intubation in OR/ICU if signs of obstruction.
- Start IV antibiotics (ceftriaxone + vancomycin); give steroids as adjunct.
- Admit to ICU; monitor closely for airway deterioration; step down when improved.
Clinical Synopsis & Reasoning
Rapidly progressive sore throat, odynophagia, drooling, muffled voice, and stridor. Avoid agitation; secure the airway with awake fiberoptic technique when needed. Give broad IV antibiotics and steroids as adjunct; admit to ICU for monitoring.
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 |
|---|---|---|---|
| Flexible nasolaryngoscopy (controlled setting) | Diagnosis | Edematous, cherry‑red epiglottis | Do not agitate/lay flat |
| Lateral neck radiograph (adjunct) | Supportive | Thumb sign | Avoid delay |
| Blood/throat cultures (selected) | Pathogen ID | H. influenzae, streptococci, staphylococci | — |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Ceftriaxone + Vancomycin (empiric) | Antibiotics | Hours | Cover typical adult pathogens | Tailor to cultures |
| Dexamethasone (adjunct) | Glucocorticoid | Hours | Reduce edema | Evidence mixed |
| Nebulized epinephrine (selected) | Vasoconstrictor | Minutes | Temporary improvement | Not definitive |
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/critical‑care reviews on adult epiglottitis — Link