Key Concept: Epiglottitis with impending airway compromise = secure airway first (OR, anesthesia + ENT). Never examine throat of a toxic child with suspected epiglottitis. Croup = outpatient dexamethasone ± racemic epinephrine; no airway emergency.
Category
Key Actions
Do First (Epiglottitis)
Call anesthesia + ENT emergently for epiglottitis
Keep child calm — avoid agitation
Allow child to remain in position of comfort (sitting up, tripod)
Prepare for emergent intubation or surgical airway
Have bag-mask and surgical airway kit at bedside
Do Second (Epiglottitis)
IV antibiotics after airway is secured (ceftriaxone covers H. flu)
Lateral neck X-ray only if patient is STABLE and diagnosis uncertain
Blood cultures after airway secured
Admission to ICU after intubation
Do NOT Do (Epiglottitis)
Do NOT examine throat before securing airway
Do NOT send to radiology first if child is toxic
Do NOT give antibiotics before securing airway if deteriorating
Do NOT give racemic epinephrine (used for croup, not epiglottitis)
Croup Treatment
Single-dose oral or IM dexamethasone (reduces subglottic edema)
Racemic epinephrine nebulization for severe croup (transient effect)
Cool humidified air
Observe 2–4 hours after epinephrine before discharge