Peds epiglottitis airway management

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MCG2012

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For those who have dealt with this, what is your preferred approach? Mask induction, IV, then intubate while maintaining spontaneous ventilation? Or do you try to start an IV then titrate IV induction agents with spontaneous ventilation? Really like to what some of you others do


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For those who have dealt with this, what is your preferred approach? Mask induction, IV, then intubate while maintaining spontaneous ventilation? Or do you try to start an IV then titrate IV induction agents with spontaneous ventilation? Really like to what some of you others do


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The board answer is the former. But i dont do peds so i never done one. Curious as to how many of these people have seen these days with vaccine and stuff. And i imagine if they go to the ER just for epiglottis, the ED docs will take care of it? (Though the Anes board answer also says do it in a OR, not sure what ED board says)
 
We still see these occasionally. If we're asked to be involved or "stand by", then it is always done in the OR with an ENT surgeon in the room.
 
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We just had an organ procurement on a adult epiglotittits - guy in his 40’s. Came to the ED with flu like symptoms, got sent home. Later developed respiratory distress at home, 911, anoxic brain injury, brain dead, donor. Sad. . . and scary.
 
We just had an organ procurement on a adult epiglotittits - guy in his 40’s. Came to the ED with flu like symptoms, got sent home. Later developed respiratory distress at home, 911, anoxic brain injury, brain dead, donor. Sad. . . and scary.

That doesn't sound good for the person who discharged
 
That doesn't sound good for the person who discharged

I’m not sure what the time frame was, but I don’t think there were any overt signs of airway compromise on that initial ER visit.
 
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I honestly have not ever seen a case, people around here still vaccinate their kids. Maybe in California you get more H.influenza cases... I guess staph/strep could still cause a case. Board answer is to NOT piss off the kid while awake. IE mask induction/IV/SV/ET We have these fancy J tip lidocaine things that I can start an iv on most kids awake and they dont feel it. Real world for me would depend. Easy IV perop sure, if not I can do it asleep. I personally would do it in the OR not the ED but that is just because I know where all the stuff is....
 
The board answer is the former. But i dont do peds so i never done one. Curious as to how many of these people have seen these days with vaccine and stuff. And i imagine if they go to the ER just for epiglottis, the ED docs will take care of it? (Though the Anes board answer also says do it in a OR, not sure what ED board says)

I can tell you from the ER perspective (and the correct answer on our oral boards) is to turf it to the OR and have anesthesia do it with ENT or a general surgeon capable of a fast cric or trach standing by in the OR. :)

In real world...I would probably do the same. Our teaching I think is similar that anything that could "piss the kid off" is to be avoided (such as an IV start) so yeah probably mask induction and then IV.
 
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Done one last year, my only one. Adult. immigrant. unvaccinated. My mate was ER doc and he rang me when she was still in the ambulance. Status asthmaticus was the initial diagnosis. In Emerg she was drooling, no big history of asthma and stridoring.

Took her straight to OR, called ent. Gassed her on sevo nitrous, 20 of ketamine. Actually put the entropy on for the laugh. When it hit 30, which wasnt very long i had a look, no relaxant with the mcgrath. Cords were fine, but epiglottis was really angry. Cant remember what she grew in the end.

Her PCO2 was 28kPa. Still put her on epi drip and iv salbutamol over night in case it was asthma
I actually think she was discharged home 3 days later. The other staff were laughing at me that i overreacted...
But they werent there that night so f them lol
 
Done one last year, my only one. Adult. immigrant. unvaccinated. My mate was ER doc and he rang me when she was still in the ambulance. Status asthmaticus was the initial diagnosis. In Emerg she was drooling, no big history of asthma and stridoring.

Took her straight to OR, called ent. Gassed her on sevo nitrous, 20 of ketamine. Actually put the entropy on for the laugh. When it hit 30, which wasnt very long i had a look, no relaxant with the mcgrath. Cords were fine, but epiglottis was really angry. Cant remember what she grew in the end.

Her PCO2 was 28kPa. Still put her on epi drip and iv salbutamol over night in case it was asthma
I actually think she was discharged home 3 days later. The other staff were laughing at me that i overreacted...
But they werent there that night so f them lol

That is insane. she had over 1 MAC of CO2 on board ... MAC of CO2 is 200 mmhg .. 28kPa = 210 mmHg CO2... She was awake with a PCO2 of 210??? What was her pH?
I guess since this was adult, you placed the IV in before induction
 
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She was very somnolent at that. Our capnogram wouldnt measure the level. Thought it was broken initially. Ill be honest i dont really understand the pathophysiology of what happened that night.
I do remember being quite animated when i was told i couldnt take her to theatre by the bed manager.

It must have been more than epiglottitis.
 
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