acute epiglottitis, a severe, rapidly progressing bacterial infection of the upper respiratory tract that occurs in young children, primarily between 2 and 7 years of age. It is characterized by sore throat, croupy stridor, and inflamed epiglottis, which may cause sudden respiratory obstruction and possibly death. The infection is generally caused by Haemophilus influenzae, type B, although streptococci may occasionally be the causative agents. Transmission occurs via infection with airborne particles or contact with infected secretions. Compare croup. ▪ OBSERVATIONS: The diagnosis is made by bacteriological identification of H. influenzae, type B, in a specimen taken from the upper respiratory tract or in the blood. A lateral x-ray film of the neck shows an enlarged epiglottis and distension of the hypopharynx, which distinguishes the condition from croup. Direct visualization of the inflamed, cherry-red epiglottis by depression of the tongue or indirect laryngoscopy is also diagnostic but may produce total acute obstruction and should be attempted only by trained personnel with equipment to establish an airway or to provide respiratory resuscitation, if necessary. ▪ INTERVENTIONS: Establishment of an airway is urgent, either by endotracheal intubation or by tracheostomy. Humidity and oxygen are provided, and airway secretions are drained or suctioned. IV fluids are usually required, and antibiotic therapy is initiated immediately. Steroids are useful. ▪ PATIENT CARE CONSIDERATIONS: Intensive nursing care is required for a child with acute epiglottitis. The most acute phase of the condition passes within 24 to 48 hours, and intubation is rarely needed beyond 3 to 4 days. As the child responds to therapy, breathing becomes easier; rapid recovery usually occurs, so bed rest and quiet activity to relieve boredom become primary concerns for the health care team.
