Acute epiglottitis is often difficult to differentiate from other common childhood causes of upper airway distress. It is not universally appreciated that sudden airway obstruction may occur without warning at any time in the first stages of the infection.
In 55 cases, the most serious error is to assume that the airway will remain patent. Twelve of forty-one patients in the "observation" group necessitated tracheotomy in less than ideal circumstances, and three experienced total respiratory arrest. The protocol adopted for diagnosis and treatment of acute airway distress emphasizes continuous readiness to intervene in controlled circumstances and routine tracheotomy if the diagnosis of acute epiglottitis is made.
Johnson GK, Sullivan JL, Bishop LA. Acute Epiglottitis: Review of 55 Cases and Suggested Protocol. Arch Otolaryngol. 1974;100(5):333–337. doi:10.1001/archotol.1974.00780040345002
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