Lesson 1

Epiglottitis vs. Laryngotracheobronchitis (Croup)

Epiglottitis

• Etiology: Bacterial (e.g., H. influenza, Group A streptococci, Pneumococci, Staphylococci)
• Age Group: Affects ages 2 - 6 years
• Onset: Rapid (< 24 hours)
• Region Affected: Supraglottic structures (e.g., epiglottis, vallecula)
• X-Ray Finding: Swollen epiglottis (Thumb sign)
• Clinical Presentation:
  • High-grade fever
  • The tripod position for breathing
  • 4 D's: Drooling, Dyspnea, Dysphonia, Dysphagia
• Treatment:
  • Oxygen
  • Urgent airway management (tracheal intubation/tracheostomy)
  • Antibiotics if bacterial
  • ENT presence required for induction

Laryngotracheobronchitis (Croup)

• Etiology: Viral (e.g., H. parainfluenzae, RSV, Influenza A & B), Bacterial (rare, e.g., Mycoplasma pneumoniae)
• Age Group: Affects ages < 2 years
• Onset: Gradual (24 - 72 hours)
• Region Affected: Laryngeal structures below the vocal cords
• X-Ray Finding: Subglottic narrowing (Steeple sign)
• Clinical Presentation:
  • Low-grade fever
  • Barking cough
  • Vocal hoarseness
  • Inspiratory stridor
  • Retractions (suprasternal, substernal, intercostal)
• Treatment:
  • Oxygen
  • Racemic epinephrine
  • Corticosteroids
  • Humidification
  • Fluids
  • Intubation rarely required
  • Post-op ICU care