Croup (Laryngo-tracheo-bronchitis)-Epoglottitis-Laryngitis

Croup in Children Introduction Etiology Clinical Presentation Diagnosis Management Complications

Introduction to Croup in Children

Croup, also known as laryngotracheobronchitis, is an acute respiratory condition characterized by inflammation of the upper airway, particularly affecting the larynx, trachea, and bronchi. It is a common childhood illness that can cause significant respiratory distress.

Key points:

• Most common in children 6 months to 3 years of age
• Peak incidence occurs in the second year of life
• More frequent in boys than girls (ratio approximately 3:2)
• Typically occurs in fall and early winter
• Can be mild to severe, with potential for airway obstruction in severe cases

Etiology of Croup in Children

Understanding the causes of croup is essential for effective management:

1. Viral Causes (Most Common):

• Parainfluenza viruses (types 1 and 3 most common)
• Respiratory syncytial virus (RSV)
• Influenza A and B viruses
• Human metapneumovirus
• Adenoviruses
• Coronaviruses (including SARS-CoV-2)

2. Bacterial Causes (Rare):

• Mycoplasma pneumoniae
• Bacterial tracheitis (a complication of viral croup)

3. Non-infectious Causes:

• Allergic reactions
• Inhaled irritants
• Reflux-induced laryngitis

4. Pathophysiology:

• Viral infection leads to inflammation and edema of the subglottic region
• Narrowing of the airway results in the characteristic "seal-like" barking cough
• Inspiratory stridor occurs due to turbulent airflow through the narrowed airway

Clinical Presentation of Croup in Children

The presentation of croup can range from mild to severe:

1. Common Symptoms:

• Barking cough (often described as "seal-like")
• Inspiratory stridor
• Hoarseness
• Respiratory distress (varying degrees)
• Low-grade fever (usually <39°C)

2. Progression of Symptoms:

• Often begins with mild upper respiratory symptoms (rhinorrhea, cough)
• Typical croup symptoms develop over 12-48 hours
• Symptoms often worsen at night
• Peak severity usually on the second or third night of illness

3. Severity Assessment:

The Westley Croup Score is commonly used:

• Mild (0-2 points): Barking cough, no stridor at rest
• Moderate (3-5 points): Stridor at rest, mild retractions
• Severe (6-11 points): Marked stridor, significant retractions
• Impending respiratory failure (≥12 points): Lethargy, cyanosis

4. Associated Symptoms:

• Tachypnea
• Tachycardia
• Decreased oral intake
• Fatigue or lethargy (in severe cases)

Diagnosis of Croup in Children

Diagnosis is primarily clinical, based on history and physical examination:

1. Clinical Assessment:

• Detailed history:
  • Onset and progression of symptoms
  • Recent exposures or illnesses
  • Vaccination status
• Physical examination:
  • Assess respiratory rate, work of breathing, and oxygen saturation
  • Listen for characteristic barking cough and stridor
  • Evaluate for signs of dehydration or fatigue

2. Diagnostic Tests (Usually Not Necessary):

• Radiography:
  • Anteroposterior neck X-ray may show "steeple sign"
  • Not routinely recommended but may help rule out other conditions
• Laryngoscopy: Reserved for atypical or severe cases
• Viral testing: Not routinely performed but may be considered in research or outbreak settings

3. Differential Diagnosis:

• Epiglottitis
• Bacterial tracheitis
• Foreign body aspiration
• Peritonsillar or retropharyngeal abscess
• Angioedema
• Anaphylaxis

Management of Croup in Children

Treatment approach depends on the severity of symptoms:

1. Mild Croup:

• Supportive care:
  • Hydration
  • Fever control (acetaminophen or ibuprofen)
  • Humidified air or cool mist (controversial, may provide comfort)
• Observation and reassurance
• Consider single dose of oral dexamethasone

2. Moderate to Severe Croup:

• Corticosteroids:
  • Dexamethasone: 0.15-0.6 mg/kg PO/IM (max 10 mg)
  • Alternative: Prednisolone 1-2 mg/kg PO
• Nebulized epinephrine:
  • L-epinephrine 1:1000 solution: 0.5 mL/kg (max 5 mL)
  • Racemic epinephrine 2.25%: 0.05 mL/kg (max 0.5 mL)
• Oxygen therapy if SpO2 <92%

3. Impending Respiratory Failure:

• Immediate airway management
• Consider intubation (preferably with an endotracheal tube 0.5-1.0 mm smaller than usual)
• ICU admission

4. Follow-up and Discharge Criteria:

• Observe for at least 2-4 hours after treatment
• Ensure adequate oral intake and absence of stridor at rest
• Provide caregiver education on warning signs and when to seek medical attention

Complications and Special Considerations

While most cases of croup resolve without sequelae, awareness of potential complications is important:

1. Potential Complications:

• Respiratory failure
• Pneumonia
• Bacterial tracheitis
• Pulmonary edema (post-extubation)

2. Recurrent Croup:

• Consider underlying conditions:
  • Subglottic stenosis
  • Laryngomalacia
  • Tracheomalacia
  • Gastroesophageal reflux disease
• Referral to ENT specialist may be warranted

3. Special Populations:

• Premature infants: Higher risk of severe disease
• Children with comorbidities: May require more aggressive management

4. Prevention Strategies:

• Hand hygiene
• Avoiding close contact with individuals with respiratory infections
• Routine childhood vaccinations (may prevent some viral causes)

5. Prognosis:

• Generally excellent with appropriate management
• Most children improve within 3-7 days
• Hospitalization rates are low (<5% of cases)

Laryngitis in Children Introduction Etiology Clinical Presentation Diagnosis Management Complications

Introduction to Laryngitis in Children

Laryngitis in children refers to inflammation of the larynx, often resulting in hoarseness or loss of voice. While usually acute and self-limiting, it can sometimes indicate more serious underlying conditions, especially in pediatric populations.

Key points:

• Most common in ages 3 months to 3 years
• Can be viral, bacterial, or due to irritants
• Often accompanies upper respiratory tract infections
• May present differently in children compared to adults

Etiology of Pediatric Laryngitis

Understanding the various causes of laryngitis in children is crucial for effective management:

1. Infectious Causes:

• Viral (most common):
  • Respiratory Syncytial Virus (RSV)
  • Parainfluenza viruses
  • Influenza viruses
  • Adenoviruses
• Bacterial:
  • Group A Streptococcus
  • Haemophilus influenzae
  • Moraxella catarrhalis

2. Non-infectious Causes:

• Allergies
• Gastroesophageal reflux disease (GERD)
• Vocal cord nodules or polyps
• Inhaled irritants (e.g., smoke, chemical fumes)
• Excessive voice use or shouting

3. Rare but Serious Causes:

• Epiglottitis
• Laryngeal diphtheria
• Foreign body aspiration
• Laryngeal papillomatosis

Clinical Presentation of Laryngitis in Children

The presentation of laryngitis in children can vary based on age and etiology:

Common Symptoms:

• Hoarseness or changes in voice quality
• Cough (often described as "barking" or "croupy")
• Difficulty swallowing or painful swallowing (odynophagia)
• Sore throat
• Fever (usually low-grade)

Age-specific Presentations:

• Infants:
  • Weak cry or inability to cry
  • Feeding difficulties
  • Inspiratory stridor
• Toddlers and Older Children:
  • Hoarse voice
  • Throat clearing
  • Vocal fatigue

Associated Symptoms:

• Runny nose or nasal congestion
• Mild dyspnea
• Fatigue
• Mild chest discomfort

Note: Severe respiratory distress, high fever, or drooling may indicate more serious conditions like epiglottitis and warrant immediate attention.

Diagnosis of Laryngitis in Children

Accurate diagnosis involves a combination of clinical assessment and, when necessary, additional tests:

1. Clinical Evaluation:

• Detailed history:
  • Onset and duration of symptoms
  • Recent illnesses or exposures
  • Voice use patterns
• Physical examination:
  • Assess overall appearance and respiratory status
  • Examine throat and neck
  • Listen for breath sounds and voice quality

2. Diagnostic Tests:

• Laryngoscopy:
  • Flexible nasolaryngoscopy for detailed laryngeal examination
  • Particularly useful in persistent or recurrent cases
• Imaging:
  • Neck X-ray: May be used to rule out epiglottitis or foreign body
  • CT or MRI: Reserved for suspected structural abnormalities or tumors
• Laboratory Tests:
  • Throat culture: If bacterial infection is suspected
  • Viral PCR: To identify specific viral pathogens

3. Differential Diagnosis:

• Croup
• Epiglottitis
• Bacterial tracheitis
• Peritonsillar abscess
• Vocal cord dysfunction
• Anaphylaxis

Management of Pediatric Laryngitis

Treatment approach depends on the underlying cause and severity of symptoms:

1. Conservative Management:

• Voice rest: Encourage quiet activities
• Hydration: Increase fluid intake
• Humidification: Use of cool mist humidifiers
• Avoid irritants: Keep child away from smoke and other airborne irritants

2. Pharmacological Interventions:

• Antipyretics/Analgesics:
  • Acetaminophen or Ibuprofen for fever and pain relief
• Corticosteroids:
  • Oral dexamethasone or prednisone in moderate to severe cases
  • Can reduce inflammation and improve symptoms
• Antibiotics:
  • Only if bacterial infection is confirmed or strongly suspected
  • Choice depends on local antibiotic resistance patterns

3. Specific Treatments:

• For GERD-related laryngitis:
  • Proton pump inhibitors or H2 blockers
  • Dietary modifications
• For allergic causes:
  • Antihistamines
  • Nasal corticosteroids

4. Monitoring and Follow-up:

• Regular assessment of respiratory status
• Follow-up in 1-2 weeks for persistent symptoms
• Referral to ENT specialist for chronic or recurrent cases

Complications and Special Considerations

While most cases of pediatric laryngitis resolve without sequelae, awareness of potential complications is crucial:

1. Potential Complications:

• Airway obstruction:
  • More common in infants and young children
  • May require immediate intervention
• Secondary bacterial infections
• Chronic laryngitis:
  • Can lead to permanent voice changes
  • May indicate underlying conditions like GERD or allergies
• Psychological impact:
  • Voice changes can affect a child's social interactions and self-esteem

2. Red Flags Requiring Immediate Attention:

• Severe respiratory distress
• Inability to swallow saliva (drooling)
• High fever with toxic appearance
• Stridor at rest
• Cyanosis

3. Long-term Management:

• Voice therapy for chronic cases
• Regular follow-ups for recurrent laryngitis
• Management of underlying conditions (e.g., GERD, allergies)
• Education on vocal hygiene

4. Prevention Strategies:

• Proper hand hygiene
• Avoiding close contact with individuals with respiratory infections
• Promoting good vocal habits
• Maintaining adequate hydration
• Avoiding exposure to secondhand smoke and other irritants

Epiglottitis in Children Introduction Etiology Clinical Presentation Diagnosis Management Complications Prevention

Introduction

Epiglottitis is a potentially life-threatening condition characterized by inflammation and swelling of the epiglottis and surrounding tissues. It can lead to rapid airway obstruction, especially in children. Although the incidence has decreased significantly since the introduction of the Haemophilus influenzae type b (Hib) vaccine, it remains an important pediatric emergency that requires prompt recognition and management.

Etiology

The most common causative agents include:

• Haemophilus influenzae type b (Hib): Historically the primary cause, now less common due to vaccination
• Streptococcus pneumoniae
• Staphylococcus aureus
• Group A streptococcus
• Viral infections (less common)

Non-infectious causes may include:

• Trauma
• Thermal injury
• Chemical irritants

Clinical Presentation

Classic symptoms include:

• Rapid onset of high fever
• Sore throat
• Dysphagia (difficulty swallowing)
• Drooling
• Muffled or "hot potato" voice
• Stridor
• Respiratory distress
• Anxiety and restlessness

Key clinical signs:

• Tripod position: Child sitting forward, mouth open, tongue protruding
• Reluctance to lie flat
• Tachycardia and tachypnea
• Cyanosis in severe cases

Diagnosis

Diagnosis is primarily clinical, but may be supported by:

• Lateral neck X-ray: "Thumb sign" - swollen epiglottis
• Flexible nasopharyngolaryngoscopy: Only if airway is secure
• Blood tests: Complete blood count, blood cultures
• Epiglottic cultures: Once airway is secured

Caution: Avoid agitating the child or manipulating the airway unnecessarily, as this may precipitate complete airway obstruction.

Management

Epiglottitis is a medical emergency requiring prompt intervention:

1. Airway management:
   • Maintain a calm environment
   • Allow child to assume position of comfort
   • Prepare for potential intubation or emergency tracheostomy
   • Avoid agitating the child or examining the throat
2. Oxygen therapy: Provide supplemental oxygen as needed
3. Intravenous access: Establish for fluid resuscitation and medication administration
4. Antibiotics: Empiric broad-spectrum antibiotics (e.g., ceftriaxone plus vancomycin)
5. Corticosteroids: To reduce inflammation (e.g., dexamethasone)
6. Intubation: Often necessary; should be performed by the most experienced practitioner available
7. Intensive care: Close monitoring in PICU setting

Complications

Potential complications of epiglottitis include:

• Complete airway obstruction
• Respiratory failure
• Pneumonia
• Sepsis
• Epiglottic abscess
• Pulmonary edema
• Neurological sequelae due to hypoxia

Prevention

Preventive measures include:

• Haemophilus influenzae type b (Hib) vaccination: Key to preventing most cases
• Antibiotic prophylaxis for household contacts of Hib epiglottitis cases
• General hygiene measures to prevent respiratory infections
• Pneumococcal vaccination may also help reduce risk

Tracheitis Introduction Etiology Clinical Presentation Diagnosis Treatment Complications Prognosis

Introduction to Pediatric Tracheitis

Tracheitis is an inflammation of the trachea, which can be particularly severe in pediatric patients. It is a rare but potentially life-threatening condition that requires prompt recognition and treatment. In children, bacterial tracheitis often occurs as a complication of a viral upper respiratory tract infection, leading to bacterial superinfection of the trachea.

The incidence of bacterial tracheitis is estimated to be around 0.1 cases per 100,000 children per year, with a peak incidence in children aged 3-8 years. It is more common in the fall and winter months, coinciding with the higher prevalence of viral respiratory infections during these seasons.

Etiology of Pediatric Tracheitis

Tracheitis in children is typically caused by bacterial infection, often following a viral upper respiratory infection. The most common causative organisms include:

• Staphylococcus aureus: The most frequent pathogen, accounting for approximately 50-65% of cases
• Streptococcus pneumoniae: Responsible for about 20-25% of cases
• Haemophilus influenzae: Seen in 10-15% of cases, particularly in unvaccinated children
• Moraxella catarrhalis: Less common but still significant
• Group A Streptococcus: Occasionally implicated

Viral infections, particularly influenza, parainfluenza, and respiratory syncytial virus (RSV), often precede bacterial tracheitis by damaging the tracheal mucosa and predisposing it to bacterial invasion.

Clinical Presentation of Pediatric Tracheitis

The clinical presentation of tracheitis in children can be dramatic and may initially resemble other upper airway obstructions. Key features include:

• Rapid onset of symptoms, often within 24-48 hours
• High fever (typically >39°C or 102.2°F)
• Toxic appearance with lethargy and ill appearance
• Stridor (both inspiratory and expiratory)
• Barking or brassy cough
• Respiratory distress with increased work of breathing
• Hoarseness or dysphonia
• Tachycardia and tachypnea
• Difficulty swallowing and drooling

It's important to note that tracheitis can rapidly progress to complete airway obstruction, making early recognition crucial.

Diagnosis of Pediatric Tracheitis

Diagnosis of tracheitis in children requires a high index of suspicion and can be challenging due to its similarity to other upper airway conditions. The diagnostic approach includes:

1. Clinical Assessment: Thorough history and physical examination
2. Imaging Studies:
   • Neck and chest X-rays: May show subglottic narrowing, irregular tracheal contour, or haziness of the tracheal air column
   • CT scan: Can provide detailed images of the trachea and surrounding structures
3. Laryngoscopy and Bronchoscopy: Gold standard for diagnosis, revealing:
   • Erythema and edema of the tracheal mucosa
   • Thick, purulent secretions adhering to the tracheal wall
   • Pseudomembranes or sloughing of tracheal mucosa
4. Microbiological Studies:
   • Tracheal aspirates for culture and sensitivity
   • Blood cultures (though often negative)
5. Laboratory Tests:
   • Complete blood count (CBC) showing leukocytosis
   • Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)

Differential diagnosis includes croup, epiglottitis, retropharyngeal abscess, and foreign body aspiration.

Treatment of Pediatric Tracheitis

Treatment of tracheitis in children requires aggressive management and often necessitates admission to a pediatric intensive care unit (PICU). The key components of treatment include:

1. Airway Management:
   • Close monitoring of respiratory status
   • Intubation may be necessary in severe cases
   • Avoid racemic epinephrine or corticosteroids, as they are ineffective in bacterial tracheitis
2. Antibiotic Therapy:
   • Empiric broad-spectrum antibiotics should be started immediately
   • Initial regimen often includes vancomycin plus a third-generation cephalosporin (e.g., ceftriaxone)
   • Adjust antibiotics based on culture and sensitivity results
   • Typical duration is 10-14 days
3. Supportive Care:
   • Intravenous fluids for hydration
   • Oxygen therapy as needed
   • Antipyretics for fever control
4. Frequent Suctioning: To remove thick secretions and maintain airway patency
5. Mechanical Ventilation: May be required in severe cases or respiratory failure

Continuous monitoring and reassessment are crucial throughout the treatment course.

Complications of Pediatric Tracheitis

While prompt treatment often leads to good outcomes, several complications can occur in pediatric tracheitis:

• Airway Obstruction: The most immediate and life-threatening complication
• Respiratory Failure: May require mechanical ventilation
• Sepsis: Due to systemic spread of infection
• Toxic Shock Syndrome: Particularly with Staphylococcus aureus infections
• Pulmonary Edema: Can occur post-extubation
• Tracheal Stenosis: A long-term complication due to scarring
• Pneumothorax: Rare but possible, especially in mechanically ventilated patients
• Cardiopulmonary Arrest: In severe, untreated cases

Close monitoring and early intervention are key to preventing these complications.

Prognosis of Pediatric Tracheitis

With appropriate and timely treatment, the prognosis for pediatric tracheitis is generally good. Key points regarding prognosis include:

• Most children recover completely within 3-5 days of starting treatment
• Mortality rates have significantly decreased with modern management, now less than 5%
• Full recovery without long-term sequelae is the norm
• Recurrence is rare but possible
• Long-term follow-up may be necessary to monitor for tracheal stenosis

Factors influencing prognosis include the speed of diagnosis, appropriateness of initial treatment, and any complications that may have occurred during the course of illness.

Croup (Laryngo-tracheo-bronchitis)

1. What is the typical age range for children affected by croup? 6 months to 3 years
2. Which virus is the most common cause of croup? Parainfluenza virus
3. What is the characteristic sound of croup? Barking cough
4. In croup, which part of the airway becomes inflamed and narrowed? Subglottic region
5. What time of day do croup symptoms typically worsen? Night
6. Which of the following is NOT a common symptom of croup? High fever (>104°F/40°C)
7. What is the Westley Croup Score used to assess? Severity of croup
8. Which medication is commonly used to reduce airway inflammation in croup? Dexamethasone
9. What is the primary goal of croup management? Maintaining airway patency
10. How is mild croup typically managed? Supportive care at home
11. What environmental factor can help alleviate croup symptoms? Cool mist or humidified air
12. Which of the following is a potential complication of severe croup? Respiratory failure
13. What is the typical duration of croup symptoms? 3-7 days
14. In which season is croup most commonly seen? Fall and early winter
15. What imaging study may be used to diagnose croup? Neck X-ray (steeple sign)
16. Which of the following is contraindicated in croup management? Sedatives
17. What is the role of antibiotics in most cases of croup? No role (viral etiology)
18. How does croup affect the voice? Hoarseness
19. What is the appropriate oxygen saturation target for children with croup? >92%
20. Which of the following is a sign of severe croup? Stridor at rest
21. What is the mechanism of action of racemic epinephrine in croup? Vasoconstriction and mucosal decongestion
22. How quickly does dexamethasone typically improve croup symptoms? Within 6 hours
23. What is the recommended dose of dexamethasone for croup? 0.15-0.6 mg/kg
24. Which of the following is NOT a risk factor for croup? Female gender
25. What is the role of heliox in croup management? Reduces work of breathing in severe cases
26. How does positioning affect a child with croup? Upright position may improve symptoms
27. What is the primary difference between viral and spasmodic croup? Presence of prodromal symptoms in viral croup
28. Which of the following is a contraindication to home management of croup? Toxic appearance
29. What is the appropriate route of administration for dexamethasone in croup? Oral or intramuscular
30. How does croup affect the child's ability to swallow? Usually not affected

Laryngitis

1. What is the primary symptom of laryngitis? Hoarseness or loss of voice
2. Which of the following is the most common cause of acute laryngitis? Viral infection
3. How long does acute laryngitis typically last? 1-3 weeks
4. What is the definition of chronic laryngitis? Symptoms lasting more than 3 weeks
5. Which of the following is NOT a common cause of chronic laryngitis? Viral infection
6. What is the primary treatment for viral laryngitis? Voice rest and supportive care
7. Which of the following professions is at higher risk for developing laryngitis? Teachers
8. What is the role of antibiotics in most cases of acute laryngitis? No role (usually viral etiology)
9. Which diagnostic test is most useful in evaluating chronic laryngitis? Laryngoscopy
10. What is the recommended duration of voice rest for acute laryngitis? 3-7 days
11. Which of the following is a risk factor for laryngitis? Smoking
12. What is the primary difference between laryngitis and epiglottitis? Severity and potential for airway compromise
13. How does laryngitis affect swallowing? Usually does not affect swallowing
14. Which of the following is NOT a recommended home remedy for laryngitis? Gargling with hot water
15. What is the role of corticosteroids in the treatment of acute laryngitis? Limited; may be used in severe cases or when rapid voice recovery is needed
16. Which of the following is a potential complication of chronic laryngitis? Vocal cord lesions
17. What is the appropriate management for laryngitis caused by vocal cord nodules? Voice therapy and possible surgical removal
18. How does reflux contribute to laryngitis? Irritation of vocal cords by stomach acid
19. What is the role of humidification in managing laryngitis? Helps moisturize and soothe the larynx
20. Which of the following is NOT a typical symptom of laryngitis? High fever
21. What is the primary difference between laryngitis in adults and children? Children are at higher risk for airway obstruction
22. How does alcohol consumption affect laryngitis? Can exacerbate symptoms and delay healing
23. What is the appropriate fluid intake recommendation for patients with laryngitis? Increased fluid intake
24. Which of the following medications may contribute to laryngitis? Inhaled corticosteroids
25. What is the role of voice amplification devices in managing chronic laryngitis? Can reduce vocal strain in susceptible individuals
26. How does laryngitis affect singing voice? Reduced range and altered quality
27. What is the primary cause of laryngitis in professional singers? Vocal overuse or misuse
28. Which of the following is a sign of potentially serious underlying pathology in laryngitis? Unilateral vocal cord paralysis
29. What is the role of antiviral medications in treating laryngitis? Generally not indicated
30. How does laryngitis affect breathing? Usually does not affect breathing in adults

Epoglottitis

1. What is the correct spelling of the condition often misnamed as "epoglottitis"? Epiglottitis
2. Which bacteria was historically the most common cause of epiglottitis in children? Haemophilus influenzae type b (Hib)
3. What age group is most commonly affected by epiglottitis in the post-Hib vaccine era? Adults
4. Which of the following is NOT a classic symptom of epiglottitis? Barking cough
5. What is the characteristic posture of a patient with epiglottitis? Tripod position (leaning forward with neck extended)
6. Which diagnostic test is considered the gold standard for diagnosing epiglottitis? Direct visualization of the epiglottis
7. What is the thumb sign on lateral neck X-ray indicative of in epiglottitis? Swollen epiglottis
8. Which of the following is the most appropriate initial management step for suspected epiglottitis? Secure the airway
9. What is the role of nebulized epinephrine in epiglottitis management? Temporary reduction of airway edema
10. Which antibiotic is commonly used as empiric therapy for epiglottitis? Third-generation cephalosporin
11. What is the typical duration of antibiotic treatment for epiglottitis? 7-10 days
12. Which of the following is a potential complication of epiglottitis? Complete airway obstruction
13. What is the mortality rate of epiglottitis with proper treatment? <1%
14. How has the incidence of pediatric epiglottitis changed since the introduction of the Hib vaccine? Significantly decreased
15. Which of the following is NOT a risk factor for adult epiglottitis? Obesity
16. What is the role of corticosteroids in epiglottitis management? Reduce inflammation and edema
17. Which imaging study is preferred in stable patients with suspected epiglottitis? Lateral neck X-ray
18. What is the appropriate positioning for a child with suspected epiglottitis during transport? Allow child to assume position of comfort
19. Which of the following procedures is contraindicated in initial management of epiglottitis? Blind nasopharyngeal intubation
20. What is the role of blood cultures in epiglottitis management? Identify causative organism
21. How does epiglottitis affect swallowing? Severe odynophagia (painful swallowing)
22. Which of the following is a sign of impending respiratory failure in epiglottitis? Drooling
23. What is the appropriate management of the airway in severe epiglottitis? Endotracheal intubation or tracheostomy
24. How does epiglottitis differ from croup in terms of onset? Epiglottitis has a more rapid onset
25. What is the role of fiber-optic nasolaryngoscopy in epiglottitis diagnosis? Allows visualization of the epiglottis without disturbing the airway
26. Which of the following organisms is an increasing cause of epiglottitis in adults? Streptococcus pneumoniae
27. What is the appropriate disposition for a patient diagnosed with epiglottitis? ICU admission
28. How does vaccination status affect the management of suspected epiglottitis? Lower suspicion in fully vaccinated individuals, but does not rule out the condition
29. What is the role of throat examination in suspected epiglottitis? Should be avoided due to risk of precipitating complete airway obstruction
30. Which of the following is NOT typically elevated in the blood tests of patients with epiglottitis? Eosinophil count

Further Reading

• Croup - StatPearls - NCBI Bookshelf
• Croup: Diagnosis and Management - American Family Physician
• Croup - New England Journal of Medicine
• Glucocorticoids for croup - Cochrane Database of Systematic Reviews

• Laryngitis - StatPearls - NCBI Bookshelf
• Pediatric Laryngitis and Tracheitis: Practice Essentials, Background, Pathophysiology
• Diagnosis and Treatment of Acute Laryngitis - American Family Physician
• Laryngitis in Children - Pediatric Clinics of North America

• Epiglottitis - StatPearls
• Epiglottitis - Medscape
• Epiglottitis (supraglottitis) and bacterial tracheitis in children - UpToDate
• Epiglottitis - Pediatrics in Review

• Medscape: Pediatric Bacterial Tracheitis
• StatPearls: Bacterial Tracheitis
• Recent Review Article on Pediatric Tracheitis
• American Family Physician: Croup and Bacterial Tracheitis