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Adult Acute Severe Sore Throat Management Guidelines for Emergency Department Doctors

21 April 2022

This clinical guideline was developed in response to a request from NHSE/I National Patient Safety Team following a reported fatality from acute epiglottitis.

This guideline is aimed at doctors who do not work in, or who have had no experience in ENT and takes account of situations where ENT may not be on the hospital site.

The guideline has been designed to be succinct but includes all relevant information to manage a patient with suspected supraglottitis.

Further detail regarding the development of the guideline and those involved is detailed below the guideline.



NHS England and NHS Improvement reviewed National Reporting and Learning System reports for England and Wales occurring between 2016 and 2019 identified the following key points;

  1. adult supraglottitis / epiglottitis is a potentially fatal condition if not recognised and treated appropriately,
  2. recognition of the condition can be a problem,
  3. management in secondary care is sometimes problematic, including:
    • issues with the best clinical environment to provide care,
    • safe patient transfers,
    • difficult airway management,
    • delayed and omitted critical medication,
    • access to functional diagnostic equipment,
    • ENT were not always involved and
    • Anaesthetics were not always involved.

The guideline has addressed these areas and can be used by a doctor (Advanced Nurse Practitioner or Physicians' Assistant if relevant) of any level, who can then start immediate treatment (by recognising the clinical signs and symptoms), who to contact for help and where to assess and treat the patient. We have signposted relevant thought processes and other relevant clinical guidelines (e.g. Difficult Airway).

Miss M Yaneza, Mr T Tatla, Mr A C Swift, the ENT UK Executive committee (2022-2022 members) and the British Laryngological Association (BLA) were involved in writing this guideline.


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