epiglotittis treatment for the BLS staff...

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yotam

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Hello all,

In epiglotittis, we learned that any contact with the mouth is dangerous for the patient, on the other hand the most immediate treatment should be airway treatment. What is the correct approach for this patient in the BLS level?
 
Dangerous how?

Airway is one of, if not the highest priority. If your patient isn't breathing, whatever you do for anything else won't matter.
 
As far as I was taught...

In the first stage the airway is highly sensitive to any trauma, even the mildest blow to the neck could triger the reaction. In the stages before full closure of the trachea (in which case I will obviously intervene with every measure I have), could invoke the pathological reaction, and therefore the caregiver should avoid any contact with the area.

Again, I've never actually seen such patient, and this is merely what I was taught. I'm addressing this thread to anybody who has attended a patient with epiglotittis and could share some tips (Even if they include debunking what I was taught:ph34r:).
 
In epiglottitis the airway needs aggressive attention either intubation or late stages a surgical or needle cric, these kids are sick, you could see tripoding, drooling, extreme agitation.

No ****ing around here get them to the hospital or snow them and intubate sooner then later , if their airway closes their done unless you have crics in you r bag of tricks. At the bls level your job is to get them als as soon as possible, try to keep them calm, sit them up and try not to aggrevate the situation at all, you won't be able to bag them once their closed, these kids don't trick you, you will know as soon as you hit the door that these kids need immediate medical attention.

There really is no treatment in the field besides aggressive airway management. It can be caused by trauma but usually its infection, its treated with antibiotics. With kids this is truly a race against time its not if but when their going to close up on you if you encounter it with an adult you may have some time but don't bet on it.
 
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Thank you...

It's pretty much what I was taught, but you sharpened it for me. Have you ever seen such a patient? what should I expect? (especially in children where the infection is much more dangerous).
 
I have seen a few, one thing is these kids look sick. I don't know what you're protocols include, humidified o2, epi neb may buy you some time, but its best if these kids conditions are addressed by someone who had the ability to place an airway. Don't sit on them, don't minimize their symptoms, they will die on you. Thorough assessment is imperative, epiglottitis can mimic other airway problems, croup and such, in my experience you don't get the barky cough usually, may be some stridor, but the key is the onset and the presence of a temp, maybe they complained of a sore throat or they didn't eat much that day, the parents can be very helpful in ruling them in for epiglotit tis.

The main thing is recognition these kids are sick and are going to die without an airway. Your really on the clock with these kids. You can't be passive with them their going to need aggressive airway management so get them a paramedic or a hospital pronto. I'm not positive and maybe some more educated and experienced providers will chime in but in my experience this is what your up against.
 
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adamjh3 said:
Dangerous how?

Airway is one of, if not the highest priority. If your patient isn't breathing, whatever you do for anything else won't matter.
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Because epiglottitis is a swelling problem so screwing around in there will just exacerbate the problem, when this kids airway slams shut your up the creek with out a paddle unless your medics can cric.

You cant bag these kids, the the epiglottis swells over the trachea and if its severe you wont be able to intubate them either.

So if you suspect it, leave their airway alone, keep them calm and get someone or somewhere that can address the airway permanently.
 
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Yes these kids are extremely sick, and need treatment urgently. Being able to hear stridor is a good sign believe it or not, because as the stridor gets quieter, this means the airway is getting more constricted.

From a BLS standpoint, cooled humidified o2 is good, unless it agitated the patient, in which case take whatever measures are necessary to not cause any duress, as this will exacerbate the issue.

It really all depends on what your transport times are. If you find the patient stridorous and tripoding and you have a 10 minute transport time, I would say supportive care and very rapid transport. If you have a longer transport time, you will need to assess very carefully what you want to do.

ANY agitation to these kids is bad. Unless it is absolutely necessary, I would be cautious about starting an IV unless you are fully prepared to intubate. You have one chance to intubate these patients, and sometimes you don't even have that chance. In fact even in the pediatric ER I used to work in (one of the largest level one trauma centers in the US) and on our critical care transport team, intubation of these patients was limited to the OR and anesthesiologist at all costs, unless completey unavoidable.

The reason I am writing all of this is to make this point... Be careful of jumping all the way in and snowing a kid who has an airway, even if it isn't ideal. You have a nearly 100% chance of missing this intubation, and surgical crocs and trachs are more easily said than done, especially in peds with inflamed upper airway anatomy.

Obviously if the child's airway is fully obstructed, all bets are off and you need to take all measures necessary to ventilate the child.
 
Call for an RSI qualified Intensive Care Paramedic or Doctor (like Brown!) with much of the fastness

Note: Brown may or may not be an RSI qualified ICP and/or Doctor
 
Tincture of "hurryup", but don't jostle em.

If you're work too far out from hospitals, get some paramedics trained and hired.
 
This is one of the patients that the best treatment, even for ALS is a massive diesel bolus.
 
Will do...

No stay & play, rapid transportation, don't touch facial area unless needed, call doctor Brown. G'otcha. thank you all, hope I won't need your help.
 
When it comes to eppiglotitis, you'll do what ALS does--- transport to the hospital safely, quickly, and without aggravating the demon-leaf.

We don't even RSI as that could end up shutting it off too. We'll have our cric kit ready, but that's about the only difference between ALS and BLS.
 
Linuss said:
When it comes to eppiglotitis, you'll do what ALS does--- transport to the hospital safely, quickly, and without aggravating the demon-leaf.

We don't even RSI as that could end up shutting it off too. We'll have our cric kit ready, but that's about the only difference between ALS and BLS.
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+1. Don't mess about. Drive expeditiously to the nearest (appropriate) hospital.

I spoke with a medical control doc about this last night after reading the post and he told me that nebulized Epi may return in one of the county's next protocol revisions.
 
n7lxi said:
+1. Don't mess about. Drive expeditiously to the nearest (appropriate) hospital.

I spoke with a medical control doc about this last night after reading the post and he told me that nebulized Epi may return in one of the county's next protocol revisions.
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We have nebulized epi, but only for croup. If we can't decide between croup or epiglottis, we treat it as epiglottis and transport.
 
A related question: A sign of epiglottitis is stridor, inspiratory wheezes in the upper airway. I was always taught that, but I never thought to ask..... if I hear stridor in the upper airway, what might I hear in the lower airway? will I hear the same wheezes?
 
You might hear the resonance in the lungs, much the same way as you'll hear the resonance of someone talking while listening to the lungs.
 
I am not advocating anyone change their protocols or giving any medical advice, but we trailed nebulized epi 1:1000 in epiglottitis cases with positive results. Worked better than the racemic, which we still reserved for ...
 
WTEngel said:
I am not advocating anyone change their protocols or giving any medical advice, but we trailed nebulized epi 1:1000 in epiglottitis cases with positive results. Worked better than the racemic, which we still reserved for ...
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I have standing orders for neb epi for croup and epiglotittis. Mainly for when we're out in the county, but we can do it even in town if needed.
 
Do you carry racemic or are you using 1:1000?
 
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