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气道观察:一例罕见的成人会厌炎病例。

Airway Watch: A Rare Case of Adult Epiglottitis.

作者信息

Adams Clates P, Ajhar Alec, Tolson Dedra R

机构信息

Emergency Medicine, Madigan Army Medical Center, Tacoma, USA.

出版信息

Cureus. 2024 Nov 6;16(11):e73160. doi: 10.7759/cureus.73160. eCollection 2024 Nov.

Abstract

Epiglottitis is an acute inflammatory condition involving the epiglottis and other supraglottic structures that may lead to airway obstruction. Historically, this condition primarily affected the pediatric population and was secondary to (Hib) infection. Since the vaccination program against Hib serotype B started at age two months, the number of affected pediatric patients has seen a drastic decline. Epiglottitis is now a condition that primarily affects adults. This case report presents a 58-year-old fully vaccinated female presenting with severe throat pain, odynophagia, subjective dyspnea, and chills for two days. During her evaluation, the patient underwent bedside nasopharyngoscopy by the emergency medicine team and was treated appropriately prior to evaluation by an otolaryngologist (ENT). The patient underwent a second nasopharyngoscopy with ENT 75 minutes after the original, which demonstrated vast improvements in the patient's clinical picture, allowing her to avoid intubation. This report highlights the importance of having epiglottitis on the differential for adults, the importance of the emergency medicine physician in performing nasopharyngoscopy, and early intervention with antibiotics and corticosteroids* to improve patient outcomes.

摘要

会厌炎是一种涉及会厌及其他声门上结构的急性炎症性疾病,可导致气道阻塞。从历史上看,这种疾病主要影响儿童群体,继发于B型流感嗜血杆菌(Hib)感染。自从针对B型流感嗜血杆菌的疫苗接种计划在两个月大时开始实施以来,受影响的儿科患者数量急剧下降。会厌炎现在主要影响成年人。本病例报告介绍了一名58岁的已完全接种疫苗的女性,她出现严重咽痛、吞咽痛、主观呼吸困难和寒战两天。在评估过程中,患者由急诊医学团队进行了床边鼻咽镜检查,并在耳鼻喉科医生(ENT)评估之前得到了适当治疗。在最初检查75分钟后,患者接受了耳鼻喉科医生的第二次鼻咽镜检查,结果显示患者的临床症状有了很大改善,从而避免了插管。本报告强调了将成人会厌炎列入鉴别诊断的重要性、急诊医学医生进行鼻咽镜检查的重要性,以及早期使用抗生素和皮质类固醇进行干预以改善患者预后的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9eed/11623979/dee3d4bae3fe/cureus-0016-00000073160-i01.jpg

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