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Acute Epiglottitis — a life-threatening supraglottic infection (typically Haemophilus influenzae type b in unvaccinated children).
Classic presentation:
- Sudden high fever, toxic appearance
- Drooling (inability to swallow secretions)
- Muffled 'hot potato' voice
- Tripod/sniffing position: leaning forward, neck extended, supporting on hands — maximizes airway opening
- Stridor (late, ominous sign)
- Anxiety, refuses to lie down
CRITICAL NURSING RULE:
NEVER examine the throat with tongue depressor, attempt IV access, take blood, agitate the child, or lay the child supine — ANY stimulation can cause complete airway obstruction.
Priority actions:
- Keep child calm, upright (let child maintain own position)
- Administer humidified O₂ gently
- Notify physician and anesthesiologist IMMEDIATELY
- Prepare for emergency intubation or tracheostomy (bedside)
- IV access and antibiotics ONLY after airway is secured
Treatment: Ceftriaxone \(100\,\text{mg/kg/day}\) IV after airway secured.
Differentiate from croup: croup has barking cough, subglottic involvement, not toxic, managed with steroids + nebulized epinephrine.
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