PE25.2 | Epiglottitis — Summary & Reflection

KEY TAKEAWAYS

Epiglottitis is an acute bacterial supraglottic infection causing rapidly progressive airway obstruction. Haemophilus influenzae type b is the classical pathogen; post-Hib-vaccine, Streptococcus pyogenes, pneumoniae, and aureus are increasingly implicated. The presentation is rapid (hours): high fever, drooling, dysphagia, muffled hot-potato voice, tripod position, and inspiratory stridor. The thumbprint sign on lateral neck X-ray confirms the diagnosis radiologically. The absolute rule is: do NOT examine the throat, do NOT place the child supine, and do NOT attempt IV access before the airway is secured — any distress can precipitate complete obstruction. Management is controlled endotracheal intubation in OT under general anaesthesia with ENT surgical backup, followed by IV ceftriaxone (50-100 mg/kg/day) and dexamethasone. PICU care follows until extubation. Rifampicin prophylaxis is offered to unvaccinated household contacts.

REFLECT

Epiglottitis is terrifying — for the child, the family, and the medical team. A child in the tripod position, drooling and struggling to breathe, is one of the most acute scenes in paediatric emergency medicine. Reflect on how you would keep yourself calm in those first few minutes: the instinct to 'do something' is powerful, but in epiglottitis the most important action is knowing what NOT to do. Consider also the role of immunisation: this condition was once far more common and far more deadly before Hib vaccination. How does this case reinforce your commitment to supporting vaccination programmes in India, particularly for families hesitant about the pentavalent vaccine?