The dysphagia does not allow them to clear their oral secretions, and they are often drooling on presentation. Physical examination should be done expediently and with careful attention so as not to increase the child's anxiety. Increased anxiety in the child may lead to reflex laryngospasm, acute airway obstruction, and respiratory arrest. Even minor annoyances to the child such as placement of electrocardiogram or ECG leads, or placement of mist by his or her face may cause the child to cry and possibly obstruct the airway. The child should remain with a trusted caretaker at all times, often in their arms.
Most hospitals have a predetermined protocol for the management of patients with epiglottitis.
It is the physician's responsibility to be aware of this protocol and institute it promptly . Necessary personnel include an anesthesiologist skilled at performing pediatric intubation, an endoscopist in the event of difficult intubation and the need for direct visualization of the airway, and an intensivist to manage the patient postoperatively. From the emergency room, the child is taken by a physician to the operating room along with the child's trusted caretaker, where further evaluation takes place with the skilled personnel and emergency equipment available. If the child shows some atypical signs or symptoms of epiglottitis, a single portable endolateral neck x-ray, with the child in the upright position, may be taken before direct visualization of the epiglottitis is done. Endolateral neck x-rays show classic swelling of the epiglottis on the lateral film.