URTObstruction - Diseases
Introduction Physical Examination Differential Diagnosis Specific Diseases Epiglottitis Clinical Diagnosis Airway management Supportive therapy Viral croup Foreign body aspiration Retropharyngeal abscess References Other Lectures		The ideal diagnostic approach is to take any patient with suspected epiglottitis to the operating room, administer anesthesia and examine the airway with a laryngoscope while the patient is anesthetized. (In particular, this should be done in the "sick" or unstable patient.) If the diagnosis of epiglottitis is made, the patient can then be intubated. If it is ruled out, the patient can return to the ER or ward to continue the workup, secure in the knowledge that epiglottitis is not present. However, many/most hospitals do not have the luxury of 24-hour availability of an in-house anesthesiologist. Therefore, a less than ideal but perfectly acceptable approach to making the diagnosis is by Xray. The patient with epiglottitis who is initially seen in the office, clinic or nontertiary emergency room should be transported to a referral hospital by ambulance with a physician in attendance. Oxygen should be given en route and equipment for airway stabilization, resuscitation and ventilatory support should be available during the transport. The patient should be allowed to assume the most comfortable position; do not force the patient to lie down. The referral hospital should be alerted as soon as possible. If respiratory arrest occurs during transport, suction the patient, then ventilate with bag and mask. Until recently, attempted visualization of the epiglottis with tongue blade and flashlight in the emergency department was considered a totally unacceptable approach to diagnosis, unless the patient was sedated and you were ready and able to intubate. The swollen, cherry-red epiglottis of the patient with epiglottitis is not as mobile as normal and does not pop up into view easily when the patient is gagged with a tongue blade. Also, this forceful handling of the patient will cause increased anxiety and stridor, which may cause complete obstruction of the patient's airway. However, current pediatric literature argues that direct visualization is both safe and accurate. Although this remains a controversial point, it seems prudent to ensure the availability of a person skilled in pediatric intubation before attempting direct visualization. Return to top of page