Haemophilus influenzae type b epiglottitis

Editor—Tanner et al describe Haemophilus influenzae type b as a cause of acute upper airways obstruction in children.1 Such epiglottitis has indeed become much less common since the introduction of the Hib vaccine, and therefore doctors are not as experienced in managing this life threatening condition now as they were previously. The vaccine is not 100% effective; so occasional cases will present, and clinicians must be aware of the dangers and how to avoid them. In the cases quoted, two of the three patients had been sent for a lateral neck x ray film before the airway was secured. This is contraindicated in patients suspected of having epiglottitis because at any time the patient may lose their airway, and a radiology department is not a safe environment to manage this problem. Doctors also should not attempt to cannulate or obtain blood samples from a patient until the airway is secure. Takingblood from a child is obviously distressing for them and may, once again, precipitate acute airway obstruction. The most important point in managing a child with acute epiglottitis is to avoid acute airway obstruction, which can happensuddenly and lead to severe consequences. Involving an anaesthetist and otolaryngologist will allow safe airway management initially, which is then followed by appropriate treatment with antibiotics.