A streptococci are most common causes in adults. For those in extremis, samples for lab tests should not be drawn and epiglottic swab culture should not be obtained until airway has been secured. Most adults present in a less acute fashion, and immediate testing is appropriate. X-ray evaluation for suspected epiglottitis is being replaced by direct visualization of the epiglottis using nasopharyngoscopy as the preferred method of diagnosis. For presentations in extremis, avoid x-ray until airway is secure because of the danger of sudden obstruction.
Most adults can safely undergo imaging.
Chest x-ray Avoid until airway is secure. CXR may reveal pneumonia. Orotracheal intubation may be required with little warning. Cricothyrotomy may be necessary for any patient with epiglottitis. Patients may deteriorate precipitously, and airway equipment, including that for cricothyrotomy, should be present in patient's bay.