Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, United States of America.
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
Am J Emerg Med. 2021 Mar;41:1-5. doi: 10.1016/j.ajem.2020.12.030. Epub 2020 Dec 23.
Ludwig's angina is a potentially deadly condition that must not be missed in the emergency department (ED).
The purpose of this narrative review article is to provide a summary of the epidemiology, pathophysiology, diagnosis, and management of Ludwig's angina with a focus on emergency clinicians.
Ludwig's angina is a rapidly spreading infection that involves the floor of the mouth. It occurs more commonly in those with poor dentition or immunosuppression. Patients may have a woody or indurated floor of the mouth with submandibular swelling. Trismus is a late finding. Computed tomography of the neck soft tissue with contrast is preferred if the patient is able to safely leave the ED and can tolerate lying supine. Point-of-care ultrasound can be a useful adjunct, particularly in those who cannot tolerate lying supine. Due to the threat of rapid airway compromise, emergent consultation to anesthesia and otolaryngology, if available, may be helpful if a definitive airway is required. The first line approach for airway intervention in the ED is flexible intubating endoscopy with preparation for a surgical airway. Broad spectrum antibiotics and surgical source control are keys in treating the infection. These patients should then be admitted to the intensive care unit for close airway observation.
Ludwig's angina is a life-threatening condition that all emergency clinicians need to consider. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.
路德维希咽峡炎是一种具有潜在致命性的疾病，在急诊科（ED）绝不能漏诊。
本文旨在为急诊科临床医生提供路德维希咽峡炎的流行病学、病理生理学、诊断和管理方面的综述，重点介绍路德维希咽峡炎。
路德维希咽峡炎是一种迅速扩散的感染，涉及口底。它在牙齿状况不佳或免疫抑制的人群中更为常见。患者可能会出现口底木僵或硬结，伴有下颌下肿胀。牙关紧闭是晚期表现。如果患者能够安全离开 ED 并能耐受仰卧位，首选颈部软组织 CT 加造影检查。如果需要明确的气道，在麻醉科和耳鼻喉科有条件的情况下，紧急咨询可能会有所帮助。ED 中气道干预的一线方法是带有手术气道准备的柔性插管内镜。广谱抗生素和手术源控制是治疗感染的关键。这些患者随后应收入重症监护病房进行密切气道观察。
路德维希咽峡炎是一种危及生命的疾病，所有急诊科临床医生都需要考虑。临床医生了解这些患者的诊断、管理和处置的最新证据非常重要。
