Epiglottitis begins with a high fever and a sore throat. Other symptoms may include abnormal breathing sounds (stridor), chills and shaking, cyanosis, drooling, dyspnea (the patient may need to sit upright and lean slightly forward in order to breathe), dysphagia, dysphonia, and voice changes (hoarseness). The etiology of epiglottitis is bacterial: Haemophilus influenzae type b (75% of cases), Group A β-hemolytic Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae.
Examination of the upper airway should be limited to noting the respiratory rate, assessing the work of breathing, and observing the level of respiratory distress. No manipulation or examination of the mouth or pharynx should be performed unless it is in a controlled setting. The anesthesiologist must be certain that all necessary bronchoscopes, endotracheal tubes, and emergency tracheostomy equipment are available. A skilled otolaryngologist must be present and should accompany the child at all times once the diagnosis is suspected, should the need for a surgical airway arise.
No blood work should be done, and no intravenous catheter should be placed. The child should be disturbed as little as possible. If parental separation would cause undue anxiety, the parents should be allowed into the operating room.
Concerns regarding a full stomach are theoretically reasonable, as these children have not fasted. However, these children are often so sick, and swallowing is so painful, that food and fluid intake has probably decreased prior to presentation.
