Jan 9, 2010 - LSU School of Medicine

Case 1
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Age 2-4 y/o
High fever, rapid onset
PE: anxious, toxic, muffled voice, drooling, stridor
Posture: tripod, “sniffing position”
Bugs: (Classically H.flu), staph, strep
Abx: Clinda + Ceftriaxone
Dx: Clinically, lat neck thumb sign
Tx: ENT/anesthesia skilled intubation + abx
Comp: Resp arrest (may occur rapidly even if pt
seems to be in no distress)
A. Peritonsillar Abscess
B. Epiglottitis
C. Ludwig Angina
D. Laryngotracheobronchitis
E. Retropharyngeal Abscess
F. Bacterial Tracheitis
Click on image to watch
Case 2
• Age < 3
• Fever, dyspnea, dysphagia, drooling, +/- stridor, resists
moving neck (most pain with extension),
– may see bulge (50%) on one side of post pharyngeal wall
• (median raphe divides space- don’t confuse with peritonsillar abscess)
• Dx: Lat neck film: prevertebral space > ½ vertebral body
(C1-C3) or > vertebral body C4,
• Bugs: GAS, Staph, anaerobes
• Tx: Clinda, Surgical drainage, Stat ENT consult
• Comp: airway obstruction, track to mediastinum or lateral
pharyngeal space (jugular thrombosis), spontaneous
drainage with asp pneumonia
A. Peritonsillar Abscess
B. Epiglottitis
C. Ludwig Angina
D. Laryngotracheobronchitis
E. Retropharyngeal Abscess
F. Bacterial Tracheitis
Case 3
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3mos- 5yrs
URI sx, barking cough, inspiratory stiridor
75% parainfluenza
Dx: Clinical. May see steeple sign
Tx: supportive, decadron, recemic-epi nebs
Croup
Case 4
• Any Age (not common in very young children)
– Think about it in older kids and teens
• Sore throat, fever, muffled voice, drooling, trismus, ear
pain, snoring, swollen tonsil with deviation of uvula
• Dx: clinical
• Group A strep, s.aureus, anaerobes
• Tx: Clinda, consult ENT for possible drainage
• Comp: spread to lateral pharyngeal abscess, airway
compromise, carotid artery sheath involvement
A. Peritonsillar Abscess
B. Epiglottitis
C. Ludwig Angina
D. Laryngotracheobronchitis
E. Retropharyngeal Abscess
F. Bacterial Tracheitis
Case 5
• Classically age <3, now seen more up to 7y/o
• Preceded by viral infxn, usually improves then
rapidly becomes toxic appearing (Biphasic)
• High fever, purulent cough, +/-stridor and
tachypnea, NO drooling, NO neck stiffness, and
can lie flat
• Staph, resp flora (moraxella, Hflu, anaerobes)
• Clinda or Vanc PLUS Cefriaxone
• 50% get intubated
• Comp: pneumonia, resp arrest, Toxic shock syn
Ragged tracheal border
Pseudomembranes
From thick exudates
A. Peritonsillar Abscess
B. Epiglottitis
C. Ludwig Angina
D. Laryngotracheobronchitis
E. Retropharyngeal Abscess
F. Bacterial Tracheitis