From the Guidelines
Prehospital treatment of epiglottitis at the paramedic level should prioritize maintaining a patent airway while minimizing patient agitation and distress, with a focus on rapid transport to a definitive care facility. The signs of epiglottitis, including stridor, difficulty swallowing, drooling, fever, and a patient sitting in the tripod position, should be promptly recognized by paramedics 1. It is crucial to keep the patient calm and in a position of comfort, typically sitting upright, to reduce the risk of airway compromise. Oxygen should be administered via non-invasive means, such as a face mask, with minimal disturbance to the patient to avoid triggering laryngospasm or complete airway obstruction.
Key considerations in prehospital management include:
- Avoiding examination of the throat or attempts to visualize the epiglottis, as this can precipitate complete airway obstruction 1
- Administering oxygen and monitoring respiratory status continuously during transport
- Being prepared for emergency airway management, including bag-valve-mask ventilation, and considering cricothyrotomy as a last resort if intubation is impossible 1
- Establishing IV access for potential medication administration, such as nebulized epinephrine to temporarily reduce airway edema
- Ensuring early notification to the receiving facility to prepare appropriate personnel and equipment for definitive airway management
The importance of careful preparation and a well-rehearsed plan for airway management cannot be overstated, as emphasized in guidelines for safer pre-hospital anesthesia 1. This includes having a standardized kit, being familiar with all equipment, and conducting a verbal challenge–response pre-induction checklist to confirm readiness for airway intervention. By prioritizing these measures, paramedics can optimize outcomes for patients with epiglottitis by minimizing morbidity, mortality, and impact on quality of life.
From the Research
Prehospital Treatment of Epiglottitis at the Paramedic Level
- The prehospital treatment of epiglottitis is crucial in preventing airway obstruction and ensuring the patient's safety until they can receive definitive care 2, 3, 4, 5, 6.
- Paramedics should be aware of the typical symptoms of epiglottitis, including fever, sore throat, muffled voice, drooling, tripod position, and stridor 2, 3, 4.
- While radiographs can be helpful in diagnosing epiglottitis, they should not delay the securing of the airway 2.
- The primary goal of prehospital treatment is to maintain a patent airway and provide supportive care until the patient can be transported to a hospital for further evaluation and management 4, 6.
- Paramedics should consider the potential for airway obstruction and be prepared to provide advanced airway management, such as endotracheal intubation, if necessary 6.
Airway Management
- Airway management is a critical aspect of prehospital care for patients with epiglottitis 4, 6.
- Paramedics should be trained in advanced airway management techniques, including endotracheal intubation and cricothyrotomy 6.
- The decision to intubate should be made carefully, taking into account the patient's clinical presentation and the potential risks and benefits of the procedure 6.
Medications and Supportive Care
- Paramedics may administer medications, such as antibiotics and corticosteroids, to help manage the patient's condition 4.
- Supportive care, including oxygen therapy and cardiac monitoring, should also be provided as needed 4, 5.
- Paramedics should be aware of the potential for complications, such as airway obstruction and cardiac arrest, and be prepared to provide emergency care if necessary 2, 3, 4, 5, 6.