USMLE Step 2 Secrets by O'Connell Theodore X
Author:O'Connell, Theodore X. [O'Connell, Theodore X.]
Language: eng
Format: epub
ISBN: 9780323225021
Publisher: Elsevier Health Sciences
Published: 2013-11-28T00:00:00+00:00
Figure 20-8 Anteroposterior radiograph of the neck region of child with croup. Note the steeple sign (white arrow). (From Wetmore RF. Pediatric otolaryngology: the requisites in pediatrics. 1st ed. Philadelphia: Mosby, 2007, Fig. 11-1.)
49. How do you recognize epiglottitis? Describe the cause and treatment.
Epiglottitis usually occurs in children 2 to 5 years old. The main cause is H. influenzae type b, thus widespread vaccination has significantly reduced the incidence of this condition. S. aureus, S. pyogenes, and S. pneumoniae are other potential causes. Look for little or no prodrome with rapid progression to high temperature, toxic appearance, drooling, and respiratory distress with no coughing. The thumb sign (describes a swollen, enlarged epiglottis; Fig. 20-9) is classic on lateral radiographs of the neck. Do not examine the throat or irritate the child in any way. You may precipitate airway obstruction. When a case of epiglottitis is diagnosed, the first step is to be prepared to establish an airway (intubation and, if needed, tracheostomy). Treat with a combination of oxacillin or cefazolin or clindamycin or vancomycin plus cefotaxime or ceftriaxone.
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