ENT Emergencies
Epiglottitis
Age 1-6 (but any age)
Uncommon since HiB vaccine but occurs in unvaccinated and from strep
Presentation
URTI that progresses to airway obstruction
Ill looking
Pyrexia
Drooling
Sitting bolt upright
Stridor
Respiratory distress – tachypnoea, recession
Absent cough distinguishes it from croup
Management
Senior anaesthetist, ENT surgeon and paediatrician
No evidence for nebulised adrenaline or steroids (but won’t do any harm)
Avoid stress
Gas induction with sevo and O2 sitting up on mums knee if necessary until child asleep
Laryngoscopy can be difficult – epiglottis and laryngeal inlet swollen and cherry red
Use a tube 1 size down from expected
Cannulate as soon as asleep
ABX – cefotaxime for HiB; penicillin for strep
Fluid resus
Croup (laryngotracheobronchitis)
Viral in 95%
6/12-5years
Presentation
URTI for a few days.
Stridor
Barking cough
Hoarse voice
Resp distress
Management
Nebulised adrenaline (5ml 1:1000) →transient improvement for 30-60mins.
Steroids – nebulised budenoside 2mg or dexamethasone 0.15mg/kg equally effective and start to work in 30mins.
Gas induction
Smaller tube
ENT surgeon standing by.
Bleeding Tonsil
More common if tonsillitis within 2 weeks prior to surgery.
Evidence that NSAIDs cause v.slightly more peroperative but not post-op bleeding.
Problems
Hypovolaemia.
Difficult airway – obscured by blood, oedematous.
Aspiration risk – stomach full of blood.
After effects of anaesthetic.
Management
Hb and X-match.
Resuscitate - seldom a catastrophic arterial bleed – venous or capillary ooze.
Senior help.
2 suction units for induction.
2 methods for induction
- RSI
- Inhalational induction in left lateral with intubation during SV
Awake extubation.
Extended monitoring in recovery.