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

6. Case 3 3mos- 5yrs URI sx, barking cough, inspiratory stiridor 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. A.Peritonsillar Abscess B.Epiglottitis C.Ludwig Angina D.Laryngotracheobronchitis E.Retropharyngeal Abscess F.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 Vanc PLUS Cefriaxone 50% get intubated Comp: pneumonia, resp arrest, Toxic shock syn

11. Pseudomembranes From thick exudates Ragged tracheal border

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