Adult Epiglottitis threatening airway: Back to basics and C.A.S.H. treatment

Infections involving the upper airway, especially epiglottitis (commonly caused by Haemophilus influenzae) have gained importance in the adult population in recent years, due to widespread vaccination against H. influenzae (HiB vaccine) in paediatric age group. Such infections may present with only fever, sore throat, voice change and odynophagia, or may have a more fulminant presentation including threatened airway and sepsis, requiring ICU admission and definitive airway placement. We present a case of an adult diabetic male, who presented to casualty with threatened airway caused by to epiglottitis and pharyngitis. He was managed with videolaryngoscopy guided endotracheal intubation, antibiotics, and ICU admission. Supportive treatment with C.A.S.H. (CPAP, Adrenaline, Steroids and Heliox) needs to be stressed upon when dealing with most upper airway obstructive causes. We present a case of acute epiglottitis in an uncontrolled diabetic male patient, with obstructed airway, requiring endotracheal intubation and ICU care. Antibiotics and C.A.S.H. treatment led to a successful recovery.