Epiglottitis

Tripoding and a thumb print sign on X-ray are your buzz words for epiglottitis that you don't want to miss as it can cause very rapid respiratory compromise requiring ICU care. We'll go over what to look out for and how to treat epiglottitis in this week's episodeThis episode was written by pediatricians Tammy Yau and Lidia Park with content support from Zachary Chaffin (pediatric critical care). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] Points:Epiglottitis can present with rapid onset fever, sore throat, difficulty breathing, and drooling. On exam, you might see stridor, retractions, and tripoding which is when the patient is leaning forward with their head tilted upward.Epiglottitis can lead to respiratory failure and may require intubationThe most common causes of epiglottitis are Staph aureus, Streptococcus pneumonoiae, and Haemophilus influenzae though the latter has decreased due to vaccination with the Hib vaccineTreatment for epiglottitis includes antibiotics like ceftriaxone and vancomycin for 7-10 days. Steroids and racemic epinephrine have not been shown to improve outcomes for epiglottitis. Sources:Croup and Epiglottitis. Mark Shlomovich, et al. Pediatr Rev (2025) 46 (7): 366–372. https://doi.org/10.1542/pir.2024-006420Epiglottitis Associated With Intermittent E-cigarette Use: The Vagaries of Vaping Toxicity. Pediatrics (2020) 145 (3): e20192399. https://doi.org/10.1542/peds.2019-2399Croup (laryngitis, laryngotracheitis, spasmodic croup, laryngotracheobronchitis, bacterial tracheitis, and laryngotracheobronchopneumonitis) and epiglottitis (supraglottitis). In: Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 8th edition, Tovar Padua LJ, Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ (Eds), Elsevier, Philadelphia 2019. Vol 1, p.175.Up to Date: Epiglottitis: Management, Clinical Features and Diagnosis