This handout is for pediatric acute epiglottitis (supraglottitis). Your care team identified this based on: tripod posture + drooling + toxic appearance in a febrile child — recognize from across the room (aap red book 2024-2025; pediatric airway-emergency literature).
Other reasons your team may use this plan: inspiratory stridor at rest + muffled "hot-potato" voice (not barky cough) (pediatric airway-emergency literature); refusal to swallow + rapid symptom progression over hours (aap red book 2024-2025); hot-liquid scald / steam / smoke / caustic ingestion / vapor inhalation with airway symptoms (pediatric airway-emergency literature).
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 |
|---|---|---|---|---|
| keep child calm with caregiver — defer throat exam, no supine, no IV, no agitation | Child upright in position of comfort on caregiver lap; minimal handling; supplemental humidified O2 blow-by only if tolerated without distress | supportive | continuous until controlled airway | Agitation / tongue-blade exam / supine positioning can precipitate complete obstruction (pediatric airway-emergency literature) |
| activate most experienced airway operator + ENT + anesthesia; prep rigid bronchoscopy + surgical-airway backup | Senior anesthesiologist + otolaryngologist to OR; difficult-airway cart, rigid bronchoscope, age-appropriate cricothyrotomy / tracheostomy set ready | system | immediate on suspicion | Definitive airway should be secured electively before obstruction by the most experienced operator (pediatric airway-emergency literature) |
| controlled OR endotracheal intubation — spontaneous-ventilation inhalational induction (sevoflurane), smaller-than-predicted ETT, NO paralysis until airway visualized | Sevoflurane inhalational induction maintaining spontaneous ventilation; ETT 0.5-1.0 size smaller than predicted; confirm placement; secure | procedure | definitive (single controlled procedure) | Spontaneous-ventilation inhalational technique preserves the airway during instrumentation; paralysis before visualization risks an unrescuable airway (pediatric airway-emergency literature) |
| bag-mask ventilation bridge then emergent surgical airway (needle vs surgical cricothyrotomy age-dependent; tracheostomy) | BMV with two-person technique + airway adjuncts as a bridge; if cannot intubate / cannot oxygenate → age-appropriate surgical airway by the most experienced operator | procedure | rescue if sudden complete obstruction | BMV is frequently effective as a bridge in epiglottitis; surgical airway is the final rescue (pediatric airway-emergency literature) |
Plan: Airway management FIRST — keep child calm, defer exam, controlled OR intubation by most experienced operator (ENT + anesthesia), surgical-airway backup; NO supine / NO IV / NO throat exam until airway plan ready (AAP Red Book 2024-2025; pediatric airway-emergency literature)
Call 911 or go to the nearest emergency room right away if you have:
Extubate in a controlled setting when supraglottic edema resolves + an air-leak develops (typically 24-72 h); complete 7-10 d antibiotics; rifampin chemoprophylaxis of household / childcare contacts if Hib confirmed with an under-immunized vulnerable contact (AAP Red Book 2024-2025); Hib + routine immunization catch-up (natural disease may not confer protection); ENT follow-up (AAP Red Book 2024-2025; IDSA)
Guideline: AAP Red Book 2024-2025 (H. influenzae type b + S. pyogenes + S. aureus chapters; post-Hib epidemiology; rifampin chemoprophylaxis) + IDSA invasive deep-neck / supraglottic empiric-therapy principles + recent (post-Hib-vaccine-era) pediatric-otolaryngology airway-emergency literature; vancomycin AUC per Rybak IDSA 2020