II. Epidemiology

  1. Affects older children than in croup (ages 1-8 years)

III. Pathophysiology

  1. Secondary infection of viral Upper Respiratory Infection (e.g. croup)

V. Symptoms

  1. Prodrome of upper respiratory symptoms
  2. Anterior Neck Pain
  3. Rapidly progresses to severe life-threatening illness
    1. Fever (abrupt onset)
    2. Stridor
    3. Cough
    4. Toxic, ill appearance

VI. Signs

  1. Toxic appearance
  2. High Fever
  3. Difficulty controlling secretions (Drooling, unable to swallow)
  4. Purulent airway secretions
  5. Respiratory distress
  6. Does not respond to Croup therapies
    1. Unresponsive to Racemic Epinephrine or mist therapy

VIII. Imaging

  1. Lateral Neck Xray
    1. Tracheal pseudomembrane
    2. Necrotic epithelium subdivides trachea lumen
  2. Bronchoscopy
    1. Tracheal pseudomembranes
    2. Purulent secretions

IX. Management

  1. Keep patient calm (same tenets for croup, Epiglottitis, Foreign Body Aspiration)
  2. Endotracheal Intubation
  3. Emergent management
    1. See Rapid Cardiopulmonary Asessment in Children
    2. See ABC Management
    3. See Respiratory Distress in the Newborn
    4. See Newborn Resuscitation
    5. See Pediatric Sepsis
  4. Broad Spectrum Antibiotics including coverage for MRSA
    1. Antibiotics are similar to those for Epiglottitis
    2. Example: Vancomycin and Ceftriaxone

X. References

  1. Dahan, Campbell and Melville (2020) Crit Dec Emerg Med 34(11): 3-10

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