Snapshot A 3-year-old boy is brought to the ER with an abrupt onset of fever (40 degrees Celsius), respiratory distress, and stridor. On examination, the boy appears acutely ill. He is sitting, leaning forward with his mouth open, and drooling. Introduction A medical emergency and cause of life threatening airway obstruction serious and rapidly progressive infection of the epiglottis and contiguous structures Epidemiology Affects children from age 3-7 Worldwide incidence has deceased with use of the H. flu vaccine and is now more commonly caused by S. pneumoniae or S. pyogenes in vaccinated populations ETIOLOGY Pathogenesis Organism most commonly caused by Haemophilus influenzae type B Presentation Symptoms rapid onset (1-3 hours) of high fever dysphagia drooling muffled voice respiratory retractions Physical exam cyanosis soft stridor patients sit with neck hyperextended and chins protruding (sniffing dog position) imaging Radiographs lateral neck x-ray shows swollen epiglottis (thumbprint sign) thickened aryepiglottic folds obliteration of the valleculae a physician should escort the child to radiology prepared to establish an airway Fiber optic examination do not examine patient's throat unless an anesthesiologist is present used to confirm diagnosis will see cherry red and swollen epiglottis and arytenoids studies Throat swap throat swab for culture will show Haemophilus influenzae type B Differential Croup, tracheitis, foreign body, retropharyngeal abscess, angioedema, laryngomalacia, vascular ring cough is specific for croup drooling is specific for epiglottitis laryngomalacia improves in the prone position vascular ring improves with neck extension Treatment Endotracheal intubation call anesthesiology and prepare to establish airway transfer to OR to perform exam Tracheostomy if necessary to maintain airway IV antibiotics ceftriaxone chloramphenicol ampicillin