Epiglottitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

A definitive diagnosis of acute epiglottitis can be confirmed by direct inspection under laryngoscopy, although this may provoke airway obstruction. The epiglottis and the surrounding structures appear erythematous and swollen. Physical examination may include:[1][2][3] tenderness of anterior neck, high temperature, increased respiratory rate in both children and adults, pharyngeal redness and cervical lymphadenopathy. In addition, patients with epiglottitis may adapt the so called tripod posture with hyper-extension of the neck, chin pointing forward and trunk and arms leaning forward.[4]

Physical Examination

Physical examination of patients suspected of having epiglottitis requires inspection of the oropharyngeal and suprapharyngeal area. A definitive diagnosis may be established by direct visualization of an erythematous and swollen epiglottis under laryngoscopy. Because of the risk of provoking airway spasm or obstruction, this procedure should be performed only when skilled personnel and equipment to secure the airway are available.[5][6]

On physical examination, patients with epiglottitis may present with the following:[1][2][3][6]

Appearance of the Patient

  • Patients with epiglottitis especially children may adapt the so called tripod posture with hyper-extension of the neck, chin pointing forward and trunk and arms leaning forward.[4]
  • They are usually acutely-ill looking.

Vital Signs

HEENT

Neck

Lungs

  • May be in obvious respiratory distress with flaring of ala nasi, subcostal and intercostal recessions.
  • Increased respiratory rate in both children and adults
  • Decreased air-entry depending of degree of airway obstruction

Extremities

  • Cyanosis

References

  1. 1.0 1.1 Charles R, Fadden M, Brook J (2013). "Acute epiglottitis". BMJ. 347: f5235. doi:10.1136/bmj.f5235. PMID 24052580.
  2. 2.0 2.1 Mayo-Smith MF, Spinale JW, Donskey CJ, Yukawa M, Li RH, Schiffman FJ (1995). "Acute epiglottitis. An 18-year experience in Rhode Island". Chest. 108 (6): 1640–7. PMID 7497775.
  3. 3.0 3.1 Ossoff RH, Wolff AP, Ballenger JJ (1980). "Acute epiglottitis in adults: experience with fifteen cases". Laryngoscope. 90 (7 Pt 1): 1155–61. PMID 6967138.
  4. 4.0 4.1 Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy". J Emerg Nurs. 31 (3): 234–5, quiz 321. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
  5. Alcaide ML, Bisno AL (2007). "Pharyngitis and epiglottitis". Infect Dis Clin North Am. 21 (2): 449–69, vii. doi:10.1016/j.idc.2007.03.001. PMID 17561078.
  6. 6.0 6.1 Achong MR (1979). "Respiratory tract infections in adults". Can Fam Physician. 25: 1189–93. PMC 2383214. PMID 21297792.

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