mr5 2-14
TRANSCRIPT
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Morning Report
Chris Dado5-2-14
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Supraglottitis/Epiglottitis
• Acute, rapidly progressing form of cellulitis of the epiglottis and surrounding structures
• Can result in complete airway obstruct• Most common bacterial pathogens– Hib (more in children)– GAS – S. pneumoniae, H. parainfluezae, S. aureus
(including MRSA)
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Supraglottitis/EpiglottitisChildren v. Adults
• Presents more acutely in pediatric population, usually present within 24 hours with high fevers, sore throat, tachycardia, and drooling while leaning forward
• Adolescents and adults: milder, severe sore throat accompanied by dyspnea, drooling, and stridor.
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Physical Exam
• Mod-severe respiratory distress • inspiratory stridor• retractions of chest wall• Oropharyngeal exam: underwhelming
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Diagnosis
• Often made on clinical grounds• Laryngoscopy: “cherry red” epiglottis • Neck radiographs: Thumbprint sign• Labs: moderate leukocytosis with PMNs, BCX
often positive
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Treatment
• Secure airway- usually more conservative with adults
• Iv antibiotics- Hib• Amp/sulbactam, cefuroxime, cefotaxime, or
CTX• Clinda or TMP-SMX for pt with allergies• 7-10 days of therapy
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prophylaxis
• If unvaccinated child under 4 exposed in household to Hib- 4 days of rifampin
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