Concluded Case

ACUTE EPIGLOTTIS

80 yrs old male patient is with confirmed case of acute epiglottis and severe irritant dry cough. No improvement with 3rd generation cephalosporin and Amoxicillin-clavulanic acid. Only linezolid is effective but it is recurrent every time. Patient is taking MDI due to ILD. No hypertension and diabetes. What is the management ?Dr. Parveen Yograj Dr. Sandeep Ghodekar

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Acute epiglottitis us amn emergency condition may need urgent life support as life saving measure. There is swelling of the epiglottis and may be extebde surrounding area causing Difficulty of swallowing Difficulty of phonation Drooling Distress The most commonly caused by haemophyllous influenza , this is usually found among the older pt as due to immunisation younger pt suffers less. Present with fever ,cough, difficulty if phonation and repiratory difficulty and treatment depends on the severity of respiratory problem due to airway obstruction so all emergency measure to be kept ready at bedside Portable xray lat view may show thumb print impression If there is mild airway obstruction Inj dexamethasone bolous dose followed by maintenance dose Inj Cef traxone 1 gm iv bd May require oxygen support by mask If there is severe symptom Intubation supraglottis with ventllation If intubation fails due to obstruction Tracheostomy may be needed.

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Acute epiglottitis us amn emergency condition may need urgent life support as life saving measure. There is swelling of the epiglottis and may be extebde surrounding area causing Difficulty of swallowing Difficulty of phonation Drooling Distress The most commonly caused by haemophyllous influenza , this is usually found among the older pt as due to immunisation younger pt suffers less. Present with fever ,cough, difficulty if phonation and repiratory difficulty and treatment depends on the severity of respiratory problem due to airway obstruction so all emergency measure to be kept ready at bedside Portable xray lat view may show thumb print impression If there is mild airway obstruction Inj dexamethasone bolous dose followed by maintenance dose Inj Cef traxone 1 gm iv bd May require oxygen support by mask If there is severe symptom Intubation supraglottis with ventllation If intubation fails due to obstruction Tracheostomy may be needed.

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Acute epiglotittis is a life threatening disease considering the laryngospasm . Severe irritant dry cough is not enough to diagnose Acute epiglotitis . Watch for 4 D "s of epiglottitis Dysphagia Dysphonia Drooling Distress . Also get an X - ray neck done for the " Thrumb print " sign CT scan will show Halloween sign . Also get indirect fibreoptic laryngoscopy to confirm the diagnosis. As most common causative organism is H.influenzae - get him vaccinated for HiB vaccine. Clindamycin or vancomycin should be the preferred antibiotic . Give a combination of Bilastine + montelukast for 2 months as there may be associated allergic rhinitis, For the time being avoid corticosteroids

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Evaluate for GERD. Hold MDI for tine being. Consider indacaterol glycopyrronium combination later on.

Dr. Parveen Yograj Dr. Sandeep Ghodekar Please help here

Laryngoscopy to r/o gerd Ppi sucralose o Sleep head raised

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