rapid intubation for epiglottitis?

[nev]

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I'm aware that examining the oropharynx is contraindicated for a patient with epiglottits. So how can intubation be done without actually irritating the oral tissues and causing the epiglottis to close?
Thanks
Nev

 

[beezar]

keep the kid calm.
have either or both a rigid bronch, person who can do trachs in the room
mask induction while sitting up
get the kid nice and deep
intubate (after IV access of course)

 

[Planktonmd]

I'm aware that examining the oropharynx is contraindicated for a patient with epiglottits. So how can intubation be done without actually irritating the oral tissues and causing the epiglottis to close?
Thanks
Nev

This is a situation where the most experienced and skilled person available has to do the intubation because things can go south very fast.
You always try to have a plan for a surgical airway in place before you start.
Mask induction as some one mentioned is appropriate for children without IV access while for adults an IV access is usually present and IV induction is safer.
Most cases of epiglottitis that we see currently are in adults and caused by Strep or Staph, they also tend to be less dramatic than the ones seen in children secondary to H. Influenza B.

 

[nev]

Thanks for the replies. Will starting an IV on a kid will trigger agitiation and crying which could cause the epiglottis to shut?

So if the epiglottis does shut, there really wont be any time to give local anesthesia to do a cricothyrodectomy, right? Thats a nightmare..😱

 

[canjosh]

Thanks for the replies. Will starting an IV on a kid will trigger agitiation and crying which could cause the epiglottis to shut?

So if the epiglottis does shut, there really wont be any time to give local anesthesia to do a cricothyrodectomy, right? Thats a nightmare..😱

1) Yes, minimal stimulation is the recommendation

2) Just cut...the pt is anoxic