Acute Epiglottitis (Airway) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Airway obstruction signs?
   Any signs of airway obstruction? (Acute supraglottic inflammation/obstruction (Hib, children 2–7; increasing in adults = supraglottitis), an airway emergency. Rapid high fever, severe sore throat, dysphagia, drooling, muffled voice, stridor, tripod/sniffing position, toxic appearance; in adults the posterior pharynx is normal in 90% but the sore throat is out of proportion to the exam, with pain on moving the larynx/hyoid (unlike croup, epiglottitis usually has no cough). Key: do not examine the throat/no tongue depressor/do not agitate/do not lay flat/do not delay for imaging (all can precipitate complete obstruction).)
   • Drooling/stridor/respiratory distress/rapid progression → Airway obstruction → secure airway first
   • Stable, no obstruction signs → Stable · monitor + antibiotics
2. [End] Stable · monitor + antibiotics
   Stable, no obstruction signs: keep upright, do not agitate; close airway observation in ICU/a monitored setting; ENT/anesthesia present with intubation standby; IV third-generation cephalosporin (ceftriaxone/cefuroxime) ± steroid + hydration. Treat as an airway emergency the moment drooling/stridor/distress appear. Diagnosis aided by flexible laryngoscopy (in a controlled setting) or, in stable patients, a lateral neck film 'thumb sign'.
3. [End] Airway obstruction → secure airway first
   Airway obstruction signs (drooling/stridor/distress/rapid progression): secure the airway first — ENT + anesthesia present, controlled intubation under awake fiberoptic guidance in the OR/a controlled setting, with cricothyrotomy/tracheostomy standby; provide oxygen, keep upright, do not lay flat/do not examine the throat. Once the airway is secured, IV broad-spectrum antibiotics (ceftriaxone ± anti-staphylococcal) + hydration + steroid; ICU.

Source guidelines & references

• Acute epiglottitis airway management (StatPearls; MSF clinical guidelines)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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