Adults – For cooperative adults, use cautious oropharyngeal techniques to assess the airway. Fiberoptic nasopharyngoscopy may also be used.  Adults are typically treated in the ICU with antibiotics, corticosteroids, and inhaled mists.  ETT intubation would only be utilized if respiratory distress developed.

Peds – This condition is most common in pediatric patients. 

Avoid stressors – anything that would make the child cry!  This includes excessive examination or establishing an IV.  This may lead to complete obstruction of the airway and cricothyroidotomy.

Securing the airway – this is the first priority.

Induction – Ideal anesthesia includes a gradual inhaled mask induction with sevoflurane, while again, avoiding stressors.  Rapid induction and paralysis is CONTRAINDICATED. Aim for deep sedation with the patient still spontaneously breathing.  During deep sedation an IV and full monitoring should be established.

Smaller ETT tube – Use a smaller-than-normal ETT tube (0.5-1.0 mm smaller) to avoid additional trauma and swelling of the airway.

Difficult intubation – Excessive swelling makes intubation difficult.

ICU admission – Anticipate admission to the ICU, followed by blood and throat cultures.  Antibiotics (ampicillin and chloramphenicol or ceftriaxone) and conversion to nasotracheal intubation is also very common.

Very rare infection of the upper airway. Inflammation extends to all supraglottic structures, which rapidly progresses to complete airway obstruction. Considered an emergency!

Generally found in children 2-7 years old. Rarely does this condition affect adults, and when it does, it is typically less urgent.

Signs and symptoms include sore throat, stridor (airway obstruction), hypersalivation, fever, and inability to swallow. Child’s voice may sound muffled. The “tripod” position is also a common finding.

Haemophilus influenzae was the most common cause. H. Influenzae Immunizations have drastically reduced the incidence of this condition. Most common modern causes include Staphylococcus aureus and streptococcal organisms.

Radiographic evidence includes the “thumb sign”. This is where the edematous epiglottis takes a thumb shape. This is a definitive sign, but is often absent.

Laryngotracheobronchitis (croup) is the most common differential diagnosis. The differences have been outlined in the table below