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Clinical Practice Guidelines: Respiratory/Epiglottitis Disclaimer and copyright ©2016 Queensland Government All rights reserved. Without limiting the reservation of copyright, no person shall reproduce, store in a retrieval system or transmit in any form, or by any means, part or the whole of the Queensland Ambulance Service (‘QAS’) Clinical practice manual (‘CPM’) without the priorwritten permission of the Commissioner. The QAS accepts no responsibility for any modification, redistribution or use of the CPM or any part thereof. The CPM is expressly intended for use by QAS paramedics whenperforming duties and delivering ambulance services for, and on behalf of, the QAS. Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury, claim, liability or damages of any kind resulting from the unauthorised use of, or reliance upon the CPM or its contents. While effort has been made to contact all copyright owners this has not always been possible. The QAS would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged. All feedback and suggestions are welcome, please forward to: [email protected] Date

April, 2016

Purpose

To ensure consistent management of patients with Epiglottitis.

Scope

Applies to all QAS clinical staff.

Author

Clinical Quality & Patient Safety Unit, QAS

Review date

April, 2018

URL

https://ambulance.qld.gov.au/clinical.html

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Epiglottitis April, 2016

Epiglottitis, or supraglottitis, is an inflammation of the lining 
 of the cartilaginous tissue that protects the airway during swallowing.

Clinical features

UNCONTROLLED WHEN PRINTED Infection of this structure is predominantly caused by the bacteria Haemophilus influenzae. It can also be caused by other bacteria 
 or viruses causing respiratory illnesses and non-infection aetiologies.[1]

•

High fever

• Sore throat/difficulty swallowing • Stridor/respiratory distress •

Drooling

•

Hoarse voice

Epiglottitis is a medical emergency. The throat should not be examined due to the risk of complete airway obstruction.

UNCONTROLLED WHEN PRINTED Epiglottitis is now very uncommon due to the routine Hib immunisation given in childhood. It used to be most prevalent 
 in paediatric patients aged 2–6 years, but now is more common 
 in adults due to streptococcus pneumoniae and viral pathogens, 
 or children who are not vaccinated.[1]

Risk assessment

• Any unnecessary disturbance of patient 
 including attempts to lie the patient down, examination of the throat or insertion of 
 an IV cannula can precipitate total airway obstruction.[2]

UNCONTROLLED WHEN PRINTED UNCONTROLLED WHEN PRINTED Figure 2.51

QUEENSLAND AMBULANCE SERVICE

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e

Additional information

CPG: Paramedic Safety CPG: Standard Cares

• Endotracheal tube intubation will be extremely difficult due to intense swelling and inflammation of the epiglottis.

UNCONTROLLED WHEN PRINTED • In severe cases, complete airway obstruction can rapidly develop within 3–6 hours.[2]

• Do not visualise the airway

• Consider alternate causes:

• Allow patient to assume position of comfort

- Inhaled foreign body - Croup - Bacterial tracheitis

• Calm the patient

UNCONTROLLED WHEN PRINTED • Avoid IV access attempts unless active resuscitation required.

Consider: • Oxygen

Note: Officers are 
 only to perform 
 procedures for 
 which they have 
 received specific 
 training and 
 authorisation 
 by the QAS.

UNCONTROLLED WHEN PRINTED Transport to hospital

Pre-notify as appropriate

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