HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIESDIAGNOSIS
■ If clinical suspicion is high, do not delay with diagnostic tests.
■ Lateral neck films: “Thumb printing sign” or CT (see Figure 14.17)
■ If direct laryngoscopy done (preferably in the OR) can see a cherry red
epiglottis
TREATMENT
■ Airway assessment is a priority.
■ Selective intubation, preferably in a setting with personnel and equipment
for difficult intubations, including fiberoptic laryngoscopy
■ Antibiotics are indicated: Cefuroxime, ceftriaxone, amp/sulb, or ampicillin
plus chloramphenicol. Steroids and humidified O 2 may be used (but no
evidence).
■ Generally, these patients are admitted to the ICU.
Croup (Laryngotracheitis)
ETIOLOGY
■ Viral etiology (parainfluenza being the most common) causing subglottic
edema/inflammation
■ Most commonly affects children age 3 months to 3 years
Bacterial tracheitislooks like
epiglottitis—fever, stridor,
toxic appearance; most
common cause is S. aureus.FIGURE 14.17. Lateral neck film showing thumb print sign of epiglottitis.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski SJ. Emergency
Medicine: A Comprehensive Study Guide, 6th ed.New York: McGraw-Hill, 2004:1497.)