First Aid for Epiglottitis
Epiglottitis medical emergency is caused by inflammation and swelling of the epiglottis, the flap of membrane-covered cartilage lying behind the tongue that keeps food and drink entering the windpipe. It is almost always caused by Hemophilus influenzae, type B (HiB). Thankfully, Epiglottitis is now a rare disease due to the implementation of widespread vaccination against HiB.
Epiglottitis develops suddenly, blocking the entrance to the windpipe; swelling also may affect the surrounding tissue of the throat, further obstructing air passage. Total obstruction can develop very rapidly, so emergency medical care is imperative. Epiglottitis is most common in unvaccinated children three to seven years of age, but it also occurs in infants and adults. The greatest danger is to young children, whose air passages are narrow and therefore easily obstructed.
Signs and Symptoms of Epiglottitis
Symptoms of epiglottitis develop quickly in a previously healthy child or after a minor upper respiratory tract infection. They include:
- Sore throat and high fever (up to 105F) which appear suddenly
- Painful swallowing and drooling
- Irritability, agitation and fear
- A muffled voice that becomes scratchy or rasping as the condition worsens. The child may be completely unable to speak.
- Labored and rapid breathing, often noisy
- Skin pallor or blueness
- Characteristic posture: sitting up, leaning forward, mouth open, tongue protruding and neck extended forward— position that facilitates breathing
- Rapid and shallow breathing as obstruction increases
- Rapid heartbeat
Seeking Medical Attention
Always call for emergency medical help if you suspect a child has epiglottitis. Do not delay in calling for help under any circumstances. A child with epiglottitis should be taken to an emergency room immediately. When en route to the hospital, follow these instructions:
- Do not inspect the child’s throat by suppressing the child’s tongue (with a spoon or another instrument). Doing so may completely block breathing.
- Do not allow the child to eat or drink.
- Do not force the child to lie down. Maintain the child’s sitting position, holding him in your lap.
Treatment of Epiglottitis
In the hospital, an emergency X-ray of the neck will be done to visualize the characteristic swelling of the epiglottis. Oxygen may be delivered via an oxygen mask. More commonly, a tube attached to a ventilator may be inserted through the child’s nose into the windpipe to ensure an open airway. Once breathing is stabilized, the medical team will place the child on antibiotic therapy, (usually intravenous) to treat the underlying infection. In rare cases, a tracheostomy (an opening is made in the neck to insert a breathing tube directly into the windpipe) may be needed. Ventilation support may be withdrawn within eight to 12 hours, but in some cases is needed for several days.
Most cases of epiglottitis can be prevented with the HiB vaccine, which is currently given at two, four, six and 12 to 15 months of age.