A nurse’s suspicions result in prompt treatment.
- Epiglottitis, inflammation and swelling of the epiglottis and surrounding supraglottic structures, is primarily caused by Streptococcus pneumoniae
- Presentation in adults includes sore throat, odynophagia, muffled voice, hoarseness, cough, and fever. Epiglottitis is rare in children.
- As a medical emergency, epiglottitis requires thorough assessment, prompt airway management, and antibiotic therapy.
ONE WEEK AGO, Tyler Mitchell*, a 46-year-old with a history of essential hypertension, non-insulin-dependent diabetes, and obesity, developed a sore throat that’s progressively worsened. His symptoms have persisted despite supportive therapy, resulting in a visit to the ED.
History and assessment
Emma triages Mr. Mitchell, who reports a subjective fever, sore throat, dysphagia, odynophagia, and nonproductive cough. OTC acetaminophen and ibuprofen have been ineffective. Emma assesses Mr. Mitchell’s vital signs: temperature 39.0° C (102.2° F), HR 144 bpm, RR 26 breaths per minute, BP 112/64 mmHg, and O2 saturation 94% on room air. Emma notes his muffled voice and escorts him to the treatment area.
Taking action
Emma places Mr. Mitchell on continuous cardiac and pulse oximetry monitoring. He’s up to date on his vaccinations and hasn’t traveled or been exposed to illness. Physical assessment reveals bilateral cervical lymphadenopathy, flushed skin, trismus, and a hoarse voice. Concerned about epiglottitis, the ED provider consults otolaryngology and anesthesiology. STAT lateral neck and chest x-rays, CBC with differential, CRP, COVID rapid antigen, influenza antigen, erythrocyte sedimentation rate, and two sets of blood cultures are ordered.
The lateral neck x-ray reveals an 8-mm thick epiglottis; chest x-ray is unremarkable. The anesthesiologist performs a fiberoptic laryngoscopy and intubation in the ED, with otolaryngology on standby to perform cricothyroidotomy, if needed. The laryngoscopy shows a thickened epiglottis, consistent with epiglottitis. Epiglottic and blood cultures are obtained. Mr. Mitchell receives a 2-g vancomycin loading dose followed by 1 g twice daily, as well as ceftriaxone 2 g I.V daily.
Outcome
Mr. Mitchell is admitted to the ICU with close airway monitoring and antibiotic therapy. On Day 3, a lateral neck x-ray shows improvement in epiglottic swelling. After a positive cuff leak test, Mr. Mitchell is extubated and transferred to a med-surg unit. His blood cultures are negative; the epiglottic culture grew Streptococcus pneumoniae. Mr. Mitchell is transitioned to Augmentin 875/125 mg twice daily for 7 days. At 5 days, he’s discharged home with primary care and otolaryngology follow up.
Education and follow-up
Woods and colleagues define epiglottitis as inflammation and swelling of the epiglottis and surrounding supraglottic structures, primarily caused by S. pneumoniae, Haemophilus influenzae type b, Staphylococcus aureus, or Streptococcus pyogenes. Although it can occur at any age, according to Woods and colleagues, it’s most common in men, ages 45 to 49 years. Sutton and colleagues note that other risks include diabetes, chronic kidney disease, immune deficiency, hypertension, substance use disorder, and a BMI >25 kg/m2. Mortality among adults ranges from 7% to 10%.
Symptoms include sore throat, odynophagia, muffled voice, hoarseness, cough, and fever. Severe cases present with stridor, respiratory distress, drooling, and tripod positioning. Stable patients undergo lateral neck x-ray and computed tomography, while unstable patients require fiberoptic laryngoscopy. Epiglottic and blood cultures guide treatment after airway stabilization.
Epiglottitis, a medical emergency, requires thorough assessment, prompt airway management, and antibiotic therapy. Patients frequently require ICU monitoring, but prognosis is good with rapid resolution. Emma’s triage assessment facilitated prompt implementation of an evidence-based treatment plan.
*Names are fictitious
Aaron Sebach is dean and professor in the College of Nursing and Health Sciences at Wilmington University, in New Castle, Delaware, and a mobile integrated health nurse practitioner at TidalHealth in Salisbury, Maryland.
American Nurse Journal. 2026; 21(7). Doi: 10.51256/ANJ072648
References
McDermott J, Sadeghi N, Anasi A, Mayer B, Ahmed I. Managing epiglottitis in adults: A comprehensive case study. Cureus. 2024;16(11)e73387. doi:10.7759/cureus.73387
Sutton AE, Guerra AM, Waseem M. Epiglottitis. 2024. StatPearls. ncbi.nlm.nih.gov/books/NBK430960/
Woods CR, Arnold S. Epiglottitis (supraglottitis): Clinical features and diagnosis. 2025. UpToDate. uptodate.com/contents/epiglottitis-supraglottitis-clinical-features-and-diagnosis
Woods CR, Arnold S. Epiglottitis (supraglottitis): Management. 2025. UpToDate. uptodate.com/contents/epiglottitis-supraglottitis-management
Key words: epiglottitis, airway management, medical emergency
