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Scary paediatric emergency: for kids, parents and doctors alike

Epiglottitis is an acute infection of the upper airway, especially the lining of the epiglottis and the larynx.

This is an acute medical emergency and a nightmare for every emergency room and accident and emergency department on this planet. It is caused by the gram-negative coccobacillus Haemophilus influenzae B and typically affects children between 2 and 7.

Typically the history is short, and the first symptoms the parents might notice is a high fever, the child complaining about a sore throat and problems swallowing. With the airway getting more narrow, the child has more and more throuble breathing and might present at the doctor lethargic, drooling and with a "hot potato voice" (meaning the child's speech sounds like it has a hot potato stuck in its mouth).

Urgent assessment in a calm atmosphere is necessary (if the child gets upset, a spasm of his laryngeal muscles could cause respiratory arrest) and paediatriciancs and an anaesthetist should be called to assist with the handling of the patient. In extreme cases, an emergency tracheostomy or assisted ventilation might be necessary. Oxygen monitoring should be initiated and continued at all time, and after initial treatment with intravenous broad spectrum antibiotics the child should be admitted to an intensive care unit until respiration and oxygen saturation is back to normal.

Fortunately, most western countries have now Haemophilus influenzae vaccination programs, so the incidence of epiglottitis should come down. Again, this is a very scary emergency for all involved, and immediate treatment is necessary.

Tip of the hat to doyle for pointing out an obvious error...

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