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Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Acute mastoiditis. Am J Emerg Med 2024; 79:63-69. [PMID: 38368849 DOI: 10.1016/j.ajem.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures. CONCLUSIONS An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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2
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Homar-Lopez A, López-García M, Cocostegui García P, Gilabert-Iriondo N, Peña-Zarza JA. Supraglottitis, a new paradigm in acute inflammation of pediatric airway. Pediatr Pulmonol 2024; 59:496-498. [PMID: 37991187 DOI: 10.1002/ppul.26769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Affiliation(s)
| | - Marta López-García
- Department of Pediatrics, Hospital Universitario Son Espases, Palma, España
| | | | | | - Jose A Peña-Zarza
- Department of Pediatrics, Hospital Universitario Son Espases, Palma, España
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
- Faculty of Medicine Palma de Mallorca, Universitat de les Illes Balears, Illes Balears, España
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3
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Khorrami A, Khorrami MA, Gheriani H. Vaping-induced acute epiglottitis: a case report. Int J Emerg Med 2023; 16:56. [PMID: 37670242 PMCID: PMC10481551 DOI: 10.1186/s12245-023-00532-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND E-cigarette use, or vaping, is an alternative nicotine delivery system that is becoming increasingly prevalent in adolescents and young adults. There is currently a lack of comprehensive research on the adverse effects of vaping on the upper airway. Acute epiglottitis is a potentially life-threatening condition that can lead to airway obstruction. It is commonly caused by bacterial infections such as streptococci, staphylococcus, and Moraxella. Adult patients with acute epiglottitis mainly present with odynophagia, dysphagia, and respiratory difficulties. The diagnosis of epiglottitis is made by direct laryngoscopy, and the mainstay of treatment is antibiotics. Bozella et al. (2020) reported a case of subacute non-infectious epiglottitis associated with e-cigarette use in a pediatric patient (Pediatrics 145(3), 2020). Here we present a case of acute epiglottitis in a healthy young adult after vaping, with a negative infectious workup. To our knowledge, there has been no such reported case of epiglottitis associated with e-cigarette use in an adult patient. CASE DESCRIPTION A previously healthy 29-year-old male with daily e-cigarette use presented to the emergency department with a severe sore throat, dysphagia, mild hoarseness, and shortness of breath, especially when lying supine. A lateral neck soft tissue radiograph revealed a thickened epiglottis with a thumb sign. Direct bedside laryngoscopy showed a swollen epiglottis, partially obstructing the supraglottic region confirming the diagnosis of acute epiglottitis. Throat and nasal swabs were negative for streptococcus and COVID-19 infection, respectively. The patient's condition improved significantly after receiving intravenous Dexamethasone and antibiotics for 2 days. Repeat laryngoscopy showed the resolution of epiglottis swelling, and subjective symptoms had resolved entirely 2 weeks following the start of the treatment. CONCLUSIONS Although bacterial infections usually cause acute epiglottitis, this case presents the second report of this condition associated with vaping with negative microbiological investigations. Therefore, we recommend that physicians consider non-infectious causes such as vaping in their differential diagnosis for patients with acute and subacute epiglottitis. More research is warranted on the utility of antibiotics in treating vaping-induced epiglottitis.
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Affiliation(s)
- Amir Khorrami
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | - Heitham Gheriani
- Department of Surgery Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
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Alotaibi FZ. Spontaneous epiglottic abscess: pathophysiology and airway management options. J Surg Case Rep 2023; 2023:rjad481. [PMID: 37614468 PMCID: PMC10444310 DOI: 10.1093/jscr/rjad481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/05/2023] [Indexed: 08/25/2023] Open
Abstract
Laryngeal abscesses are rare in the modern antibiotic era. This report presents a novel case of an epiglottic abscess in a patient with diabetes who developed respiratory distress and was managed by awake intubation in the emergency room followed by transoral incision and drainage of the abscess and tracheostomy. Full recovery after 1 week of intravenous antibiotic treatment was observed. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described risk factor for spontaneous epiglottic abscess development.
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Affiliation(s)
- Fahad Z Alotaibi
- Department of Otolaryngology—Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University IMSIU, Riyadh 13317-4233, Saudi Arabia
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5
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Yamada A, Yamazaki K, Sugimoto T. Response to Letter to the Editor: "Acute Bacterial Epiglottitis and COVID-induced Angioedema of the Larynx Are Possible Differential Diagnoses". Intern Med 2022; 61:3767. [PMID: 36198608 PMCID: PMC9841118 DOI: 10.2169/internalmedicine.0863-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Aki Yamada
- Department of Medicine, National Hospital Organization Higashi-Ohmi General Medical Center, Japan
| | - Kai Yamazaki
- Department of Otorhinolaryngology, National Hospital Organization Higashi-Ohmi General Medical Center, Japan
| | - Toshiro Sugimoto
- Department of Medicine, Shiga University of Medical Science, Japan
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6
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Bamadhaf W, AlRahma A, Ali K, Hamoud K. Influence of Non-invasive Ventilation in an Adult Patient With Acute Epiglottitis: A Case Report. Cureus 2022; 14:e30595. [DOI: 10.7759/cureus.30595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
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7
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Mitchell M, Buras M, Shutter M, Wieters JS. Breakthrough COVID-19 infection inducing acute epiglottitis in an immunized host. Proc AMIA Symp 2022; 35:658-660. [DOI: 10.1080/08998280.2022.2079343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Matthew Mitchell
- College of Medicine, Texas A&M Health Science Center, College Station, Texas
| | - Madison Buras
- Department of Otolaryngology, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | - Mollie Shutter
- Department of Emergency Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | - J. Scott Wieters
- Department of Emergency Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas
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8
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High risk and low prevalence diseases: Adult epiglottitis. Am J Emerg Med 2022; 57:14-20. [PMID: 35489220 DOI: 10.1016/j.ajem.2022.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/31/2022] Open
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Fernandes-Teles AR, Pina-Amado JM, Pereira JM, Paiva JA, Rocha-Silva S. Approaching the airway in prehospital emergency is a common and potentially life-saving practice. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:65-70. [PMID: 35181262 DOI: 10.1016/j.redare.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/26/2021] [Indexed: 06/14/2023]
Abstract
Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.
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Affiliation(s)
- A R Fernandes-Teles
- Department of Anaesthesiology, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal.
| | - J M Pina-Amado
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| | - J M Pereira
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Paiva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - S Rocha-Silva
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
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10
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Predictors of airway intervention in acute supraglottitis (AS), a recent 7- year experience. Am J Otolaryngol 2021; 42:103084. [PMID: 34044211 DOI: 10.1016/j.amjoto.2021.103084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/16/2021] [Indexed: 02/08/2023]
Abstract
AIMS Acute supraglottitis (AS) can be a life threatening infection that may lead to sudden airway obstruction. Thankfully, paediatric instances have decreased with public health vaccination programmes. Owing to the nature of the location of pathology, this time sensitive emergency requires astute clinical acumen and awareness of early warning signs. This study aimed to i) determine if the incidence of AS has changed over time; ii) investigate geographical and seasonal variation of infection; iii) identify features of presentation which may predict airway intervention; iv) assess efficacy of treatment and make recommendations for management. MATERIALS AND METHOD All adult patients admitted to a tertiary hospital with the diagnosis of acute supraglottitis between 2013 and 2021 were included. Diagnosis was confirmed with flexible nasendoscopy and consultant review. Demographics, management and outcomes were recorded. Statistical analysis was performed by calculating means and standard deviation for descriptive purposes. Fischer's exact test and two tailed t-test for categorical and continuous variables respectively. Results were deemed significant if P values of less than or equal to 0.05 were calculated. RESULTS Forty-three adults were identified. Five patients (11.6%) required airway intervention. Stridor, respiratory distress and CRP of >100 mg/L were noted to be significant predictive factors for airway intervention. Intubated patients had a significantly longer hospital stay. Regions with a higher population density were noted to have a higher incidence but this did not prove to be significant. CONCLUSION This is the largest study of AS in Ireland to date. There is a trend towards increasing incidence of acute supraglottitis in adults. Factors such as stridor, respiratory distress and elevated CRP should alert the clinician to the possible need for airway intervention. Acute supraglottitis is more common in higher density populated regions.
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11
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Fernandes-Teles AR, Pina-Amado JM, Pereira JM, Paiva JA, Rocha-Silva S. Approaching the airway in prehospital emergency is a common and potentially life-saving practice. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00109-2. [PMID: 34544597 DOI: 10.1016/j.redar.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 06/13/2023]
Abstract
Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.
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Affiliation(s)
- A R Fernandes-Teles
- Department of Anaesthesiology, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal.
| | - J M Pina-Amado
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| | - J M Pereira
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Paiva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - S Rocha-Silva
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
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12
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Natali D, Le H, Nguyen Ngoc C, Tran Ngoc M, Tran Khanh C, Hovette P. A 62-year-old man with stridor and dyspnoea. Breathe (Sheff) 2021; 17:200201. [PMID: 34295388 PMCID: PMC8291950 DOI: 10.1183/20734735.0201-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/13/2021] [Indexed: 11/06/2022] Open
Abstract
A 62-year-old man, without any past medical history, but a current 10-pack–year smoker, consulted a pulmonologist at the outpatient department for a gradually worsening dyspnoea over 1 year. Dyspnoea occurred first at exercise but, for 1 week, he felt short of breath, even at rest. He also reported a chronic cough with white sputum and frequent blood streaks. His voice was not affected and he had no swallowing difficulties. He lost 4 kg over the previous 3 months, along with a loss of appetite and tiredness. He did not have fever, night sweats, chest pain or choke. Stridor is a sign of vital emergency that immediately orientates towards a laryngeal or tracheal obstruction. This case report focuses on the management of stridor, which comprises emergency securing of airways and parallel aetiological investigations.https://bit.ly/39CTjOg
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Affiliation(s)
- Delphine Natali
- Respiratory Medicine Dept, Hanoi French Hospital, Hanoi, Vietnam
| | - Hoan Le
- Respiratory Medicine Dept, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Minh Tran Ngoc
- Pathology Dept, Hanoi Medical University Hospital, Hanoi, Vietnam
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13
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Pelzman FN, Tung J. A Symptom-Directed Paradigm for the Evaluation and Management of Upper Respiratory Tract Infections. Med Clin North Am 2021; 105:199-212. [PMID: 33246520 DOI: 10.1016/j.mcna.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Upper respiratory tract infections are one of the most common challenges in ambulatory medicine. Effective evaluation involves identification, primarily through the history, of the dominant set of patient symptoms leading to accurate diagnosis. Certain more morbid illnesses that mimic common upper respiratory symptoms can also be excluded with this approach. Treatment should address patient preferences through an understanding of the limited utility of antibiotics and through tailored advisement of the numerous pharmacologic options for symptom relief.
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Affiliation(s)
- Fred N Pelzman
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 505 East 70th Street, New York, NY 10021, USA.
| | - Judy Tung
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 505 East 70th Street, New York, NY 10021, USA. https://twitter.com/JudyTungMD
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14
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Kovaleski C, Jeffreys K, Riney LC. A Rare Cause of Respiratory Distress in a Toddler. Clin Pediatr (Phila) 2019; 58:927-930. [PMID: 31027428 DOI: 10.1177/0009922819845159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Kristen Jeffreys
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lauren C Riney
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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15
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Shi Y, Zhang B, Cai M, Xu W. Coupling Effect of Double Lungs on a VCV Ventilator with Automatic Secretion Clearance Function. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2019; 16:1280-1287. [PMID: 28221999 DOI: 10.1109/tcbb.2017.2670079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
For patients with mechanical ventilation, secretions in airway are harmful and sometimes even mortal, it's of great significance to clear secretion timely and efficiently. In this paper, a new secretion clearance method for VCV (volume-controlled ventilation) ventilator is put forward, and a secretion clearance system with a VCV ventilator and double lungs is designed. Furthermore, the mathematical model of the secretion clearance system is built and verified via experimental study. Finally, to illustrate the influence of key parameters of respiratory system and secretion clearance system on the secretion clearance characteristics, coupling effects of two lungs on VCV secretion clearance system are studied by an orthogonal experiment, it can be obtained that rise of tidal volume adds to efficiency of secretion clearance while effect of area, compliance, and suction pressure on efficiency of secretion clearance needs further study. Rise of compliance improves bottom pressure of secretion clearance while rise of area, tidal volume, and suction pressure decreases bottom pressure of secretion clearance. This paper can be referred to in researches of secretion clearance for VCV.
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Abstract
This article reviews the presentation, diagnosis, and management of common and "can't miss" infections of the oropharynx, including streptococcal pharyngitis, infectious mononucleosis, peritonsillar abscess, retropharyngeal abscess, and epiglottitis.
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Affiliation(s)
- Matthew R Klein
- Department of Emergency Medicine, Northwestern University, 211 East Ontario - Suite 300, Chicago, IL 60611, USA.
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17
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Ren S, Shi Y, Cai M, Zhao H, Zhang Z, Zhang XD. ANSYS-MATLAB co-simulation of mucus flow distribution and clearance effectiveness of a new simulated cough device. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2978. [PMID: 29504248 DOI: 10.1002/cnm.2978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 05/07/2023]
Abstract
Coughing is an irritable reaction that protects the respiratory system from infection and improves mucus clearance. However, for the patients who cannot cough autonomously, an assisted cough device is essential for mucus clearance. Considering the low efficiency of current assisted cough devices, a new simulated cough device based on the pneumatic system is proposed in this paper. Given the uncertainty of airflow rates necessary to clear mucus from airways, the computational fluid dynamics Eulerian wall film model and cough efficiency (CE) were used in this study to simulate the cough process and evaluate cough effectiveness. The Ansys-Matlab co-simulation model was set up and verified through experimental studies using Newtonian fluids. Next, model simulations were performed using non-Newtonian fluids, and peak cough flow (PCF) and PCF duration time were analyzed to determine their influence on mucus clearance. CE growth rate (λ) was calculated to reflect the CE variation trend. From the numerical simulation results, we find that CE rises as PCF increases while the growth rate trends to slow as PCF increases; when PCF changes from 60 to 360 L/min, CE changes from 3.2% to 51.5% which is approximately 16 times the initial value. Meanwhile, keeping a long PCF duration time could greatly improve CE under the same cough expired volume and PCF. The results indicated that increasing the PCF and PCF duration time can improve the efficiency of mucus clearance. This paper provides a new approach and a research direction for control strategy in simulated cough devices for airway mucus clearance.
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Affiliation(s)
- Shuai Ren
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Yan Shi
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
- The State Key Laboratory of Fluid Power Transmission and Control, Zhejiang University, Hangzhou, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Maolin Cai
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Hongmei Zhao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhaozhi Zhang
- Department of Statistical Science, Duke University, Durham, NC, USA
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18
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Latona A, Latona A. Meningococcal epiglottitis in a healthy adult patient: The first documented case in Australia. Emerg Med Australas 2018; 30:591-592. [DOI: 10.1111/1742-6723.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Akmez Latona
- Emergency Department; Ipswich General Hospital; Ipswich Queensland Australia
| | - Ashraaf Latona
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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19
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Gottlieb M, Long B, Koyfman A. Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. J Emerg Med 2018. [PMID: 29523424 DOI: 10.1016/j.jemermed.2018.01.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pharyngitis is a common disease in the emergency department (ED). Despite a relatively low incidence of complications, there are many dangerous conditions that can mimic this disease and are essential for the emergency physician to consider. OBJECTIVE This article provides a review of the evaluation and management of group A β-hemolytic Streptococcal (GABHS) pharyngitis, as well as important medical conditions that can mimic this disease. DISCUSSION GABHS pharyngitis often presents with fever, sore throat, tonsillar exudates, and anterior cervical lymphadenopathy. History and physical examination are insufficient for the diagnosis. The Centor criteria or McIsaac score can help risk stratify patients for subsequent testing or treatment. Antibiotics may reduce symptom duration and suppurative complications, but the effect is small. Rheumatic fever is uncommon in developed countries, and shared decision making is recommended if antibiotics are used for this indication. Oral analgesics and topical anesthetics are important for symptom management. Physicians should consider alternate diagnoses that may mimic GABHS pharyngitis, which can include epiglottitis, infectious mononucleosis, Kawasaki disease, acute retroviral syndrome, Lemierre's syndrome, Ludwig's angina, peritonsillar abscess, retropharyngeal abscess, and viral pharyngitis. A focused history and physical examination can help differentiate these conditions. CONCLUSIONS GABHS may present similarly to other benign and potentially deadly diseases. Diagnosis and treatment of pharyngitis should be based on clinical evaluation. Consideration of pharyngitis mimics is important in the evaluation and management of ED patients.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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20
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Abstract
Epiglottitis is a rarely encountered infection in pediatrics since the advent of the conjugate Haemophilus influenzae type b vaccine first introduced in the United States in 1985. However, the disease remains a much feared infection in pediatrics. The literature reiterates the importance of early recognition, avoidance of agitating the patient, and the need for securing the airway in the operating room as key and essential features to a good outcome. However, with only 1 case per 200,000 children reported in the United States in 2006, most practitioners have never encountered this infection. The following is a case of a previously healthy and immunized child who presented to our emergency department and whose condition was ultimately diagnosed as epiglottitis.
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21
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Matsuura H, Fukumura T. Thumb and vallecula signs in acute infectious epiglottitis. CMAJ 2017; 189:E1289. [PMID: 29038322 DOI: 10.1503/cmaj.170194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hiroki Matsuura
- Mitoyo General Hospital, Himehama, Toyohama-cho, Kanonji-city, Kagawa, Japan
| | - Takashi Fukumura
- Mitoyo General Hospital, Himehama, Toyohama-cho, Kanonji-city, Kagawa, Japan
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Lee SH, Yun SJ, Kim DH, Jo HH, Ryu S. Do we need a change in ED diagnostic strategy for adult acute epiglottitis? Am J Emerg Med 2017; 35:1519-1524. [DOI: 10.1016/j.ajem.2017.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022] Open
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Abstract
INTRODUCTION Emergency Departments are inundated by patients with respiratory illness during the winter months. Emergency physicians are required to quickly identify critically ill patients among the large volume of patients with mild upper respiratory illness. Among these life-threatening conditions is acute epiglottitis. CASE PRESENTATION We report a rare series of four adult patients who presented to our Emergency Department during a period of only one week in April 2015 and were ultimately diagnosed with acute epiglottitis. Three of the patients improved with conservative measures and were observed in the intensive care unit. One patient required an emergent tracheostomy. DISCUSSION This series of patients is unique in that all four patients presented to a single Emergency Department within a few days of each other and, despite a myriad of presenting chief complaints, the patients were eventually found to have the same potentially life-threatening diagnosis.These cases reinforce the variability of presenting symptoms and physical examination findings that can occur in patients with epiglottitis. They also highlight clinical findings and adjunctive testing that can help identify patients who would most benefit from intervention.
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Affiliation(s)
- Benjamin Lindquist
- Former Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in Stanford, CA.
| | - Sybil Zachariah
- Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in Stanford, CA.
| | - Anita Kulkarni
- Emergency Physician at the Santa Clara Medical Center in CA.
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Singh A, Thawani R, Thakur K. Crack cocaine-induced laryngeal injury. Am J Emerg Med 2016; 35:381.e5-381.e7. [PMID: 27623083 DOI: 10.1016/j.ajem.2016.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022] Open
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25
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de Asua I, Sorrentino E. Fulminant meningococcal supraglotittis in an immunosuppressed patient. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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26
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SHI YAN, NIU JINGLONG, CAI MAOLIN, XU WEIQING. DIMENSIONLESS OPTIMIZATION STUDY ON A VENTILATOR WITH SECRETION CLEARANCE FUNCTION. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415500323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To improve the efficiency and safety of secretion clearance, a novel ventilator (SC ventilator) with an automatic secretion clearance function is proposed. To lay a foundation for the optimization of the SC ventilator, the basic mathematical model of the ventilation system is derived. By selecting the appropriate reference values, the basic mathematical model is transformed to a dimensionless expression for simulation. Through the experimental and simulation study on the SC ventilation system, it can be concluded that: firstly, the mathematical model is proved to be authentic and reliable. Secondly, the influences of the three key parameters on the dynamics of the SC ventilation system are carried out. Last, to guarantee the pressure in the lung is higher than the expiratory positive airway pressure, the dimensionless minimum pressure in the flexible tube should be set higher than 0.9164, the dimensionless suction pressure should be set higher than 0.79.
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Affiliation(s)
- YAN SHI
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, P. R. China
| | - JINGLONG NIU
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, P. R. China
| | - MAOLIN CAI
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, P. R. China
| | - WEIQING XU
- School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, P. R. China
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Suzuki S, Yasunaga H, Matsui H, Fushimi K, Yamasoba T. Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database. Laryngoscope 2014; 125:2072-8. [DOI: 10.1002/lary.25114] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/14/2014] [Accepted: 12/01/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Sayaka Suzuki
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
- Department of Otolaryngology and Head and Neck Surgery; Faculty of Medicine, The University of Tokyo; Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics; Tokyo Medical and Dental University Graduate School of Medicine; Tokyo Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery; Faculty of Medicine, The University of Tokyo; Tokyo Japan
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28
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Abstract
Epiglottitis is a life-threatening entity that can present in children or adults. Although the incidence has declined since the introduction of the Haemophilus influenzae type B vaccine in 1985, cases continue to be identified in high-risk populations. In pediatric oncology patients specifically, epiglottitis has been reported after initiation of chemotherapy. We report the first case of epiglottits as the initial presentation of leukemia in a pediatric patient.
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Schibli A, Weisser M, Bingisser R, Widmer AF, Battegay M. [Initial patient assessment of infectious diseases and diagnostic steps with fever]. Internist (Berl) 2013; 54:911-24. [PMID: 23780560 DOI: 10.1007/s00108-012-3139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The initial assessment of patients with infectious diseases is challenging because of the extremely broad differential diagnosis as well as different host pathogen interactions influenced by a different immune status. The formal initial assessment, including the present and past medical history, thorough physical examination, clinical first impressions as well as routine laboratory analyses, is the basis of every preliminary diagnosis. Specific chief complaints have to be recognized in order to narrow down the differential diagnosis. In cases of life-threatening illnesses, such as septicemia, endocarditis, bacterial meningitis and severe pneumonia, the first diagnostic and therapeutic steps should be performed in a rapid sequence: bacterial blood samples, sputum and/or liquor samples are required and the initial antibiotic therapy has to be chosen empirically as the relevant bacterial spectrum related to the suspected illness must be covered. In less urgent cases it is recommended that a multi-step diagnostic approach be carried out which takes the differential diagnosis into account and prioritizes the probabilities. In the latter situation antibiotic treatment should be delayed to diagnose the infection correctly. Importantly, atypical courses must necessitate careful and critical reassessment of the diagnosis.
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Affiliation(s)
- A Schibli
- Klinik für Infektiologie & Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
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Abstract
There are many causes of acute severe upper airway obstruction (UAO) in children. The timing of symptom onset and the presence of fever will help to distinguish infectious from non-infectious conditions. Signs and symptoms from congenital malformations often present at birth but may also develop over time. The most common cause of UAO in children is croup. Choking on a foreign body also occurs relatively frequently. Evaluation of the child with UAO starts with a detailed history followed by a thorough physical examination, including an assessment of severity. Severe airway obstruction will result in respiratory failure. This situation requires an immediate response. A child with partial airway obstruction may initially have an adequate airway. However, this situation can deteriorate rapidly. Therefore, providing supportive care and mobilizing resources for definitive airway management may be the most appropriate interventions.
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31
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Goodman BM, Boggs JP, Tahhan SG, Ryal JL, Chen IA. Infectious disease emergencies: frontline clinical pearls. Med Clin North Am 2012; 96:1033-66. [PMID: 23102476 DOI: 10.1016/j.mcna.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article reviews various infectious disease emergencies from an internist's perspective. Key epidemiologic, diagnostic, and therapeutic points are reviewed with an emphasis on timely and appropriate initial management. The content serves to highlight essential points that are discussed in subsequent articles in this issue and to elucidate pearls that may facilitate timely and appropriate management.
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Affiliation(s)
- B Mitchell Goodman
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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A new era in supraglottitis? An isolated UK case of supraglottitis secondary toNeisseria meningitidis. The Journal of Laryngology & Otology 2011; 125:1206-8. [DOI: 10.1017/s0022215111002027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report the first UK case of supraglottitis secondary toNeisseria meningitidis.Method:Case report with review of the current literature on supraglottitis and its aetiology.Results:An 89-year-old woman was referred with worsening symptoms of dysphagia, hoarseness and neck discomfort. After nasopharyngoscopy and neck X-ray, supraglottitis was diagnosed. Prompt treatment comprised nebulised adrenaline, oxygen therapy and intravenous antibiotics. Microbiology samples grewN meningitidis, a notifiable disease in the UK. Public health officials were informed, and full precautions and prophylactic treatment initiated for those at risk. The patient made excellent progress and was discharged several days later.Discussion and conclusion:Supraglottitis occurs in <4 per 100 000 population. Following a successful UK childhood immunisation programme, most cases occur in adults. Supraglottitis secondary toN meningitidisis exceptionally rare, with only seven other reported cases worldwide. Morbidity is exceptionally high; over 60 per cent of patients require airway intervention. To our knowledge, this is the first reported UK case of supraglottitis secondary toN meningitidis. This case highlights the important clinical, diagnostic and therapeutic interventions required to prevent complications associated with this potentially fatal condition.
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Le Gac MS, Delahaye L, Martins-Carvalho C, Marianowski R. Rinofaringitis. EMC - PEDIATRÍA 2010; 45:1-5. [PMID: 32308526 PMCID: PMC7159022 DOI: 10.1016/s1245-1789(10)70176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
La rinofaringitis es la infección más banal de la primera infancia. Se trata de una enfermedad de adaptación y se ve favorecida por diversos factores que conviene conocer en detalle para disminuir la frecuencia en la población y las recidivas en una misma persona. Esta infección vírica carece de gravedad siempre que no se presente en su forma complicada o crónica. Su tratamiento consiste sobre todo en el lavado de las fosas nasales con suero fisiológico, la evitación (cuando sea posible) de los factores de riesgo) y la adenoidectomía, cuyas indicaciones están bien definidas.
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