Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA.
Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA.
Am J Emerg Med. 2022 Jul;57:14-20. doi: 10.1016/j.ajem.2022.04.018. Epub 2022 Apr 20.
Adult epiglottitis is a serious condition that carries with it a high rate of morbidity and even mortality due to airway occlusion.
This review highlights the pearls and pitfalls of epiglottitis in adult patients, including diagnosis, initial resuscitation, and management in the emergency department (ED) based on current evidence.
Epiglottitis is a life-threatening emergency that occurs more commonly in adults in the current medical era with vaccinations. Children present more commonly with acute respiratory distress and fever, while adults present most commonly with severe dysphagia in a subacute manner. Other symptoms may include drooling, muffled voice, and dyspnea. Streptococcus and Staphylococcus bacteria are the most common etiologies, but others include viral, fungal, caustic, thermal injuries, and autoimmune. Lateral neck radiographs assist in diagnosis, but they may be falsely negative. Visualization of the epiglottis is the key to diagnosis. Airway assessment and management are paramount, which has transitioned from direct laryngoscopy to flexible intubating endoscopy and video laryngoscopy with assistance from anesthesia and/or otolaryngology if available. Along with airway assessment, antibiotics should be administered. Corticosteroids and nebulized epinephrine are controversial but should be considered. Patients should be admitted to the intensive care setting for close airway observation or ventilatory management if intubated.
An understanding of epiglottitis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
成人会厌炎是一种严重的疾病，由于气道阻塞，其发病率和死亡率都很高。
本综述强调了成人会厌炎的要点和陷阱，包括根据现有证据在急诊科进行诊断、初步复苏和管理。
会厌炎是一种危及生命的紧急情况，在当前有疫苗接种的医疗时代，更常见于成年人。儿童更常表现为急性呼吸窘迫和发热，而成年人更常以亚急性方式出现严重的吞咽困难。其他症状可能包括流口水、声音嘶哑和呼吸困难。链球菌和葡萄球菌是最常见的病因，但其他病因包括病毒、真菌、腐蚀性、热损伤和自身免疫。侧颈 X 光片有助于诊断，但可能呈假阴性。会厌的可视化是诊断的关键。气道评估和管理至关重要，这已经从直接喉镜检查转变为带插管的柔性纤维内镜检查和视频喉镜检查，如果有麻醉和/或耳鼻喉科医生的协助则可以进行。除了气道评估外，还应给予抗生素。皮质类固醇和雾化肾上腺素有争议，但应考虑使用。如果需要插管，患者应入住重症监护病房，以便密切观察气道或进行通气管理。
了解会厌炎可以帮助急诊临床医生诊断和治疗这种潜在致命的疾病。
