A 4 year old patient comes in with their parent. The child complains of a severe sore throat. They also have a fever of 102.1. The child has been extremely irritable and will not eat anything for the last 2 days (per parent).
Upon examination, they sound like they have a muffled voice and you notice some drooling. The patient appears very ill and having some difficulties breathing…stridor is heard.
Vaccinations: The parent says they think they are “behind on a couple, but not sure which ones.”
A neck X-ray is done and thumbprint sign is seen.
What is the most likely diagnosis?
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ANSWER
EPIGLOTTITIS
WHAT: “A cellulitis of the supraglottis that may cause airway compromise”- Epocrates
LABS: CBC: may likely see leukocytosis
TESTS: Neck X-ray reveals Thumbprint sign
S/S: Fever, dysphagia, pharyngitis, toxic appearing, irritability
RISK: Non-vaccination with Hib vaccine
PHYSICAL EXAM: May see drooling, stridor, muffled “hot potato” voice, tripod position, acute distress
TREATMENT: Secure airway, supplemental oxygen, IV antibiotics, IV steroids, posible intubatiuon
CAUTION: DO NOT TRY TO EXAMINE THESE PATIENTS THROATS WITH TONGUE DEPRESSORS! MAY LEAD TO SPASMS THUS-LARYNGEAL OBSTRUCTION
REFERENCE:
- Epocrates: Epiglottitis. I highly recommend signing up for Epocrates. There is a free (drugs) and a paid version- runs anywhere from 150-200 per year-but so worth it! I have been using it for years and years and couldn’t go without it! I use it more than any other medical app.
DISCLAIMER: The information posted is not intended to serve as medical advice. This is for educational purposes only. This information is intended for medical professionals & students only. All patients should ALWAYS check with their primary care provider with any questions regarding their health. This is not intended to guide in medical decisions or treatment in any way. As always, medical professionals should call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly. Med Made Ez (MME) disclaims any liability for the decisions you make based on this information. |
