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Case 1

Case 1. 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

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Case 1

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  1. Case 1 • 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)

  2. Peritonsillar Abscess • Epiglottitis • Ludwig Angina • Laryngotracheobronchitis • Retropharyngeal Abscess • Bacterial Tracheitis

  3. Click on image to watch

  4. 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

  5. Peritonsillar Abscess • Epiglottitis • Ludwig Angina • Laryngotracheobronchitis • Retropharyngeal Abscess • Bacterial Tracheitis

  6. Case 3 • 3mos- 5yrs • URI sx, barking cough, inspiratorystiridor • 75% parainfluenza • Dx: Clinical. May see steeple sign • Tx: supportive, decadron, recemic-epi nebs

  7. Croup

  8. 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

  9. Peritonsillar Abscess • Epiglottitis • Ludwig Angina • Laryngotracheobronchitis • Retropharyngeal Abscess • Bacterial Tracheitis

  10. 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 VancPLUS Cefriaxone • 50% get intubated • Comp: pneumonia, resp arrest, Toxic shock syn

  11. Ragged tracheal border Pseudomembranes From thick exudates

  12. Peritonsillar Abscess • Epiglottitis • Ludwig Angina • Laryngotracheobronchitis • Retropharyngeal Abscess • Bacterial Tracheitis

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