Clinical Diagnosis and Management of Epiglottitis and Emergency Upper Airway Problems

Epiglottitis Recognition and Immediate Action

The American College of Physicians recommends obtaining blood cultures immediately to avoid airway manipulation, and never using a tongue depressor to examine the throat, as this can trigger sudden complete airway obstruction 1, 2
Adults with suspected epiglottitis should be positioned upright and leaning forward to optimize airway patency, and blood cultures should be obtained immediately 1, 2
The American College of Physicians explicitly recommends against throat swabbing for cultures in patients with suspected epiglottitis 1

The American College of Physicians recommends discussing with an intensivist and preparing for emergency airway intervention immediately when epiglottitis is suspected, with a primary goal of maintaining oxygenation 2
The American Society of Anesthesiologists recommends assembling difficult airway equipment, including videolaryngoscope, supraglottic airway devices, and surgical airway equipment, before any intervention 2
Patients with suspected epiglottitis should be kept upright if conscious, and provided with supplemental humidified oxygen without forcing them into a supine position 2

The Anaesthesia journal recommends following the ABCDE assessment and immediately attempting to pass a suction catheter to check for tube patency in patients with tracheostomy tubes 4
In tracheostomy emergencies, applying oxygen to both face and stoma simultaneously, deflating the cuff if suction catheter won't pass, and removing the tracheostomy tube if necessary, are key steps 4, 5

The American Society of Anesthesiologists recommends determining whether awake intubation or post-induction approach is safer by assessing four key factors: suspected difficult laryngoscopy/intubation, suspected difficult mask/supraglottic ventilation, increased aspiration risk, and increased rapid desaturation risk 6
Any single factor alone may warrant awake intubation, and limiting the number of attempts, testing mask ventilation after each attempt, and moving rapidly to alternative techniques, are recommended in emergency situations with failed intubation 3, 6

The Journal of Allergy and Clinical Immunology recommends considering Exercise-Induced Laryngeal Dysfunction (EILD) in the differential diagnosis of upper airway emergencies, characterized by inspiratory stridor during exercise that resolves within 5 minutes of stopping 7