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let's switch to another infection a
little bit lower down in the throat now
which is epiglottitis remember the
epiglottis is that flap of tissue that
closes over the trachea and prevents us
from aspirating liquids when we drink
historically epiglottitis was much more
common than it is now it seems to be
protecting more on multiple choice tests
than a dozen real-life so I see
epiglottitis very rarely and this is
because of the remarkable efficacy of
the Hamas influenza B vaccine this is a
fantastic vaccine that has dramatically
improved the quality and the extent of
children's lives so epiglottitis because
there's really no more H flu type B in
the United States is now very rare
causative organs outside you the United
States can still be absolutely H flu or
perhaps unmute eyes children within the
United States but there's other bacteria
that can cause it such as streptococcus
or staph aureus so what you should know
about this is the clinical presentation
of apricot itis this is a rapid onset
disease these patients are in grave
distress they have a high fever they'll
have a sore throat and they will be
toxic appearing they're really terrified
about their breathing and their
breathing is remarkably tenuous these
patients will be sitting forward and
almost leaning forward in a tripod
position because they're trying to keep
that airway open they'll have a hot
potato voice what that means is if you
put hot potatoes in your mouth you'll
buy a haul harder her Hyeok ha like that
that's a hot potato voice and that's
what they'll sound like because they're
trying to keep that airway open they may
also have Strider the noise we typically
see in patients with a narrowed upper
airway
if you suspect epiglottitis this is a
dramatic emergency patients can easily
die from epiglottitis you have to
examine them remarkably carefully
because there are reports of patients
going in respiratory distress
arrest simply due to the exam that
leaning forward is what's keeping them
alive so leave the child in their most
comfortable position lab testing doesn't
help you with this diagnosis patients
may get distress from a blood draw which
then causes them to go into arrest
so no labs are indicated diagnosis may
be made by getting a lateral neck x-ray
and seeing this here it's called a
thumbprint sign that's because that
epiglottitis has caused an inflammation
of the epiglottis which makes it rounded
almost like you could imagine a
thumbprint right there do you see that
thumbprint
that's the thumbprint sign now it's gone
now it's there so we managed this
through emergent involvement of the
pediatric airway specialists we need to
call an ear an ear nose and throat
doctor or an anesthesiologist somebody
who's capable of doing perhaps even
fibrous copic intubation we're going to
get control of that airway first and
we're gonna have to innovate that
patient and we may in rare circumstances
need to put in a tracheostomy because
this airway is so intense and we're
unable to innovate after the child has
coated typically we will obtain F of a
lot of cultures and then provide
broad-spectrum antibiotics to try and
reduce the airway inflammation
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you