Croup/Epiglottitis
Croup Epiglottis produces swollen airways and breathing difficulties due to inflammation of the epiglottis, surrounding structures, or both. Epiglottitis causes severe swelling of the upper airways, culminating in respiratory arrest and suffocation.
Pathophysiology
The epiglottis of a child is more anteriorly and superiorly positioned than that of an adult, and the trachea is also curved in a more slanted manner. The subglottis is the narrowest section of an infant’s airway, which is the glottis in adults. The cartilage in an infant’s epiglottis is more malleable than that of an adult, which is more inflexible. As a result, a kid is more susceptible to symptoms caused by the infectious process, which may result in edema, which increases epiglottis mass and weight. This argument is because a child’s cartilage is more pliant, causing the epiglottis edematous to draw across the laryngeal airway inspirationally (ball-wave effect).
An increase in epiglottic mass and weight caused by a single epiglottic infection, on the other hand, could be countered by more stiff epiglottic cartilage or laryngeal cartilage. In any case, additional supraglottis tissues engulfed in infection-causing edema may result in a rickety airway and possible symptoms.
Epidemiology
Research indicates that there has been a drop in epiglottitis cases in most nations throughout the world after the HIB vaccine was added to the baby immunization schedule. Nonetheless, the number of adult cases has remained constant. Following the administration of the vaccination, the age of the pediatric population with epiglottis has migrated upwards from three to six to twelve years old.
Physical Exam Findings
Physical exam findings of the epiglottis in nursing may include drooling or patients’ inability to regulate their secretions, stridor, and tripod position (having the head forward, tongue out, and sitting up on hands).
Differential Diagnoses and Rationale
The availability of the HIB vaccine has resulted in a decrease in H. influenzae-caused acute epiglottitis. The infection, however, remains the principal cause of the illness in both children and adults. As a result, most healthcare providers, including nurses, have a limited understanding of the illness, causing them to begin antibiotic treatment late. Following acute epiglottitis, a patient’s airway may become easily obstructed.
Management Plan
Since the airway is the most important part of the treatment, it must be secured before being admitted to the Intensive Care Unit. Nursing practitioners, among other healthcare providers, must intubate patients with fragile airways. Experienced caretakers, especially one capable of performing a tracheotomy, should be accessible. Culture swabs must be supplied following tube installation during intubation. Non-intubated patients must be admitted to be supervised to ensure that a tracheostomy tray is always available. When an emergency airway is required, the surgeon and anesthesiologist should be alerted. Antibiotics are also required for oral cavities and common respiratory issues.
References:
Kivekäs, I., & Rautiainen, M. (2018). Epiglottitis, Acute Laryngitis, and Croup. Infections of the Ears, Nose, Throat, and Sinuses, 247–255. https://doi.org/10.1007/978-3-319-74835-1_20
