Clinical focus: a look at epiglottitis

Yellow kit bag

Epiglottitis is an intense swelling of the epiglottis and surrounding tissues caused almost exclusively by haemophilius influenza type B. It is predominantly seen in children from ages one to six, and is now fairly uncommon in the UK thanks to the Hib vaccination.

Typically, a child suddenly develops a high fever and is lethargic, pale and toxic. They are usually sitting immobile with their mouth open and chin raised, and there may be excessive drooling owing to an inability to swallow saliva (it’s painful to do so).

Whilst Hib is commonly thought of as a childhood condition, of the small number of cases that do occur nowadays, most affect adults with long-term (chronic) underlying medical conditions, rather than young children due to the success of the vaccination programme.  This means you should not rule out epiglottitis in adults and should be vigilant to the signs by taking a thorough history and be particularly suspicious if the patient complains of an unusual sore throat or hoarseness of the voice.  Patients may be more at risk if their immune system does not work properly; for example, if they have had chemotherapy or have HIV.

Remember your ABCDE

Airway – Swelling of the epiglottis leads to severe obstruction of the upper airway. Complete obstruction is fatal and can occur if the condition is untreated or if the patient becomes distressed.

Breathing – There is an increased respiratory rate and effort, a muffled or hoarse voice, soft respiratory stridor and absent or minimal cough. Respiratory failure is due to the upper airway obstruction.

Circulation – This is normal until decompensated respiratory failure develops. Inappropriate management can lead to sudden cardiorespiratory arrest because of compete airway obstruction.

Disability – Tiredness and decreasing levels of consciousness are worrying signs of decompensated respiratory failure. Exhaustion is a pre-terminal state.

Exposure – The patient may be dribbling saliva, looking flushed, ‘toxic’ and unwell. There may be no specific rash to see.


Epiglottitis is a medical emergency that requires immediate treatment and admission to the nearest hospital.

Oxygen should be administered and an attempt made to secure the airway.  This may be profoundly swollen so give consideration to contacting the CCD early to request the enhanced care team or Air Ambulance attendance if appropriate. Immediately transfer the patient to hospital with a pre-alert giving your clinical impression as early antibiotics and a surgical airway are likely to be required. If in any doubt, contact the Clinical Advice Line for further assistance.

If cardiorespiratory arrest occurs, the patient should be ventilated by bag-valve mask ventilation and this should be continued until the child is intubated or a surgical airway obtained.

Published 9th August 2014 

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