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)

A.Peritonsillar Abscess B.Epiglottitis C.Ludwig Angina D.Laryngotracheobronchitis E.Retropharyngeal Abscess F.Bacterial Tracheitis

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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

A.Peritonsillar Abscess B.Epiglottitis C.Ludwig Angina D.Laryngotracheobronchitis E.Retropharyngeal Abscess F.Bacterial Tracheitis

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

Croup

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

A.Peritonsillar Abscess B.Epiglottitis C.Ludwig Angina D.Laryngotracheobronchitis E.Retropharyngeal Abscess F.Bacterial Tracheitis

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 Vanc PLUS Cefriaxone 50% get intubated Comp: pneumonia, resp arrest, Toxic shock syn

Pseudomembranes From thick exudates Ragged tracheal border

A.Peritonsillar Abscess B.Epiglottitis C.Ludwig Angina D.Laryngotracheobronchitis E.Retropharyngeal Abscess F.Bacterial Tracheitis