Initial airway management for patients with epiglottitis

RSI: rapid sequence intubation.
* Until the airway is secured in young children (6 years of age or younger), avoid intravenous access, unnecessary physical examination (oropharyngeal or laryngeal examination with a tongue blade or other instruments), and diagnostic tests (eg, phlebotomy or epiglottic cultures) which may provoke anxiety or crying with abrupt airway obstruction.
¶ The approach to endotracheal intubation in older children with ≤50% obstruction is on a "case by case" basis depending on the full clinical picture, degree of estimated airway obstruction, and availability of pediatric intensive care capability to safely observe unintubated children.
Δ Supraglottic airway use is contraindicated in patients with severe hypopharyngeal pathology, such as epiglottitis. Refer to UpToDate topics on rapid sequence intubation in children.
◊ Refer to UpToDate topics on needle and surgical cricothyrotomy.
§ Children with epiglottitis should receive ongoing care in a pediatric intensive care unit.