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Old 12-21-2011
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Question Initial test for Epiglottitis; X ray or Laryngoscopy?

A child comes in with the sudden onset of high fever, sore throat, drooling, dysphagia, and inspira-tory stridor.
Swallowing is painful. The symptoms cause the child to sit up, lean forward, and hyperextend the neck. The voice is
muffled. Cough is absent.

What is the best initial test?

GIVE REASONS TOO...
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Old 12-21-2011
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well, if you have a patient with those symptoms, you should go direct to laryngoscopy...you only have ONE chance to do it right
X-ray?...takes time...the kid can died in the meantime
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Old 12-21-2011
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Quote:
Originally Posted by bebix View Post
well, if you have a patient with those symptoms, you should go direct to laryngoscopy...you only have ONE chance to do it right
X-ray?...takes time...the kid can died in the meantime
But doing laryngoscopy can percipitate laryngeal spasm which can cause asphyxia and death???????? x-ray seems safe!!!!!!!!!
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Quote:
Originally Posted by daulath singh View Post
But doing laryngoscopy can percipitate laryngeal spasm which can cause asphyxia and death???????? x-ray seems safe!!!!!!!!!
does not matter, if you can see the cords, you are good to go (laryngeal spasm = succi)
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Old 12-21-2011
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answer was x ray as initial test.???
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Old 12-21-2011
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Default Epiglottitis

This is from UpToDate 19.3
Last literature review version 19.3: September 2011 | This topic last updated: May 10, 2011

Examination:
-Defer examination of the pharynx in children with signs of moderate/severe respiratory distress
-Examine the patient in the upright position
-Attempt to visualize the epiglottis (with aid of tongue depressor, direct or indirect laryngoscopy) only in patients with mild distress and not in those with more severe distress
-Maintain the child in a position of comfort with parent present
-Avoid invasive procedures

Findings:
Stridor, drooling, suprasternal and subcostal retractions
Swollen, erythematous epiglottis, inflammation of the supraglottic structures
Look for signs of extra-epiglottic infection (eg, pneumonia)

Imaging:
Soft-tissue radiograph of the lateral neck (portable if possible) when the clinical diagnosis is in doubt
Defer imaging in patients with severe respiratory distress or in whom it will delay definitive visualization of the epiglottis

Findings:
Enlarged epiglottis ("thumb" sign), loss of vallecular air space, thickened aryepiglottic folds, distended hypopharynx, loss of cervical lordosis


Management
Secure the airway, if time allows, in the operating room by anesthesia or otolaryngologist (artificially or surgically if necessary)

If abrupt obstruction:
Attempt bag-valve mask ventilation first
During laryngoscopy, pressure on the chest by an assistant may produce bubbling and help indicate the location of the glottis
Perform needle cricothyrotomy or surgical cricothyrotomy if unable to ventilate or intubate
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