This handout is for acute epiglottitis / supraglottitis (airway-emergency triage, controlled airway, iv cephalosporin). Your care team identified this based on: rapid-onset severe sore throat / odynophagia out of proportion to a near-normal oropharynx ± "hot-potato" voice — the cardinal adult epiglottitis presentation (bridwell/long am j emerg med 2022 pmid 35489220; gottlieb j emerg med 2018 pmid 29523424).
Other reasons your team may use this plan: stridor, drooling, tripod/sniffing posture, toxic appearance — impending supraglottic airway obstruction; in a child do not agitate or examine the throat (sideris laryngoscope 2020 pmid 31173373; bridwell am j emerg med 2022 pmid 35489220); sore-throat / quinsy engine flagged airway/deep-space red flags and routed in by engine_id (reciprocal entry from ent.pharyngitis.core.v1 / ent.peritonsillar-abscess.core.v1) (gottlieb j emerg med 2018 pmid 29523424); lateral soft-tissue neck radiograph showing the "thumbprint sign" (swollen epiglottis) — supportive when airway stable; a negative film does not exclude epiglottitis (bridwell am j emerg med 2022 pmid 35489220).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| controlled_airway_OR_ICU_anaesthesia_ENT_surgical_backup_do_not_agitate_child | — | — | — | Felton West J Emerg Med 2021 (PMID 34787558) — failed/difficult airways cause the deaths and anoxic injury; secure the airway in a controlled setting (OR for a child) with the most experienced operator, anaesthesia + ENT present, and a scrubbed surgical-airway (tracheostomy/cricothyroidotomy) backup. Do NOT examine a child's throat with a tongue depressor, cannulate, or lie supine before the airway is controlled (Bridwell Am J Emerg Med 2022 PMID 35489220) |
Plan: Controlled-airway pathway, empiric IV third-gen cephalosporin ± anti-staph/MRSA, debated adjuncts, source-control routing
Call 911 or go to the nearest emergency room right away if you have:
Post-extubation airway review and documentation of the difficult-airway event for future anaesthetic alerts. Identify and address the substrate: diabetes optimisation (a hard predictor), immunocompromise work-up if atypical/fungal/recurrent, Hib vaccination if unvaccinated and indicated. Counsel on recurrence (recurrent supraglottitis runs a more severe course — Shapira Galitz Laryngoscope 2017 PMID 28493349). ENT follow-up to confirm mucosal resolution; ACE-inhibitor cessation + allergy/immunology referral if the episode was angioedema rather than infection.
Guideline: Bridwell/Long/Koyfman Am J Emerg Med 2022 "High risk and low prevalence diseases: Adult epiglottitis" (PMID 35489220) + Sideris et al, Laryngoscope 2020 systematic review & meta-analysis of predictors of airway intervention in adult epiglottitis (30 studies, 10,148 patients, PMID 31173373) + Gottlieb/Long/Koyfman J Emerg Med 2018 pharyngitis-mimics review (PMID 29523424) + O'Brien et al, Acad Emerg Med 2026 10-y multicentre cohort of early steroid/antibiotic therapy (PMID 42023439) + Felton et al, West J Emerg Med 2021 adult-epiglottitis cohort (PMID 34787558) + Shapira Galitz et al, Laryngoscope 2017 (358 adults, PMID 28493349); Hib-vaccine epidemiology shift McVernon Epidemiol Infect 2005 (PMID 16288684) / Madore Infect Agents Dis 1996 (PMID 8789595)