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首页> 外文期刊>The Internet Journal of Emergency and Intensive Care Medicine >Case Series Of Acute Epiglottitis In Immunized Adults
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Case Series Of Acute Epiglottitis In Immunized Adults

机译：免疫成人急性会厌炎病例系列

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Acute epiglottitis in adults is an uncommon condition but potentially life threatening. The condition is of particular concern to anaesthetists and intensivists as it can rapidly progress to upper airway obstruction. We describe the presentation and management of three cases of acute epiglottitis in immunized adults all of which were associated with significant upper airway obstruction. Introduction Acute epiglottitis has traditionally been described as a paediatric disease. It is rare in developed countries and in adults. Its incidence is increasing with 0-7% mortality. Now a day it is due to either failed or lack of immunization. The common pathogens responsible for this disease are; Haemophilus influenzae, Haemophilus parainfluenzae and Streptococcus pneumoniae.Although pharyngitis is the most common cause of sore throat in the adults, acute epiglottitis must be considered in the differential diagnosis when there is unrelenting throat pain and minimal objective signs of pharyngitis(1). Patients with acute painful dysphagia should be considered to have epiglottitis until proven otherwise. Early diagnosis and aggressive airway management can be life saving.We review three cases of acute epiglottitis in immunized adults who presented at our institution during six months. It is important for anaesthetists and intensive care specialists to be able to manage upper airway obstruction resulting from acute epiglottitis and have a clear understanding of the aetiology and the pathophysiology of this condition. Case Reports Case 1A 24 year old male presented with one day history of sore throat, dysphagia, drooling of saliva and pyrexia. . His airway was assessed to be at risk. In the operating theatre inhalation induction was used ,but cords could not be visualized so anaesthesia was maintained with sevoflurane and a surgical tracheostomy was performed successfully. Patient was transferred to the intensive care unit and was discharged to ward on the third day. On fifth day nasal flexible endoscopy showed minimal swelling of epiglottis with normal cords. The tracheostomy was removed on ninth day and he was discharged home two days later. H.influenzae was isolated from blood culture and treated with Cefotaxime.Case 2 A 22 years old female presented to Emergency department with three days history of dysphagia and drooling of saliva. She was assessed immediately by ENT and aesthetic teams. Flexible nasal endoscopy showed an inflamed epiglottis. She received oxygen, hydrocortisone and cefotaxime. In operating theatre her airway was secured with an oral endotracheal tube following inhalation induction with sevoflurane in 100% oxygen. She was transferred to the Intensive Care Unit where she was ventilated for two days. Blood and throat swabs were sent for culture. She was extubated on third day and discharged to ward. On fifth day flexible nasal endoscopy demonstrated some inflammation of the epiglottis. On seventh day she was discharged to home. Blood cultures were negative. Streptococcus pneumoniae was isolated from the throat swab and treated with cefotaxime for seven days.Case 3A 33 years old male presented to the Emergency department with a four day history of being unwell with pyrexia and drooling of saliva. He was unable to phonate. He was treated immediately with intravenous hydrocortisone, oxygen, racemic adrenaline and cefotaxime. Flexible nasal endoscopy showed swelling of the supraglottic area, with oedema of the cords. He was intubated in theatre following an inhalation induction with sevoflurane in 100% oxygen. He was transferred to the Intensive Care unit, where he was extubated after forty eight hours and discharged to ward. Flexible nasal endoscopy on fifth day showed a normal epiglottis.Haemophilus.influenzae was isolated from blood culture and treated with cefotaxime.
机译：成人急性会厌炎并不常见，但是可能危及生命。麻醉师和强化医生特别关注这种情况，因为它会迅速发展为上呼吸道阻塞。我们描述了在免疫成人中出现并处理三例急性会厌炎的病例，所有这些病例均与明显的上呼吸道阻塞有关。引言急性会厌炎传统上被描述为儿科疾病。在发达国家和成人中很少见。它的发病率以0-7％的死亡率上升。现在一天是由于免疫失败或缺乏免疫。造成这种疾病的常见病原体是;流感嗜血杆菌，副流感嗜血杆菌和肺炎链球菌尽管咽炎是成年人咽喉痛的最常见原因，但在咽喉疼痛不缓解且咽喉炎的客观症状极少的情况下，鉴别诊断中必须考虑急性会厌炎（1）。患有急性疼痛性吞咽困难的患者应被认为患有会厌炎，除非有其他证明。早期诊断和积极的气道管理可以挽救生命。我们回顾了六个月在我们机构就诊的三例经免疫接种的成人急性会厌炎。对于麻醉师和重症监护专家而言，重要的是要能够处理由急性会厌炎引起的上呼吸道阻塞，并对这种情况的病因和病理生理学有清楚的了解。病例报告病例1A 24岁男性，有喉咙痛，吞咽困难，唾液流口水和发热的一天病史。 。他的呼吸道有危险。在手术室中使用了吸气诱导，但无法看到脐带，因此使用七氟醚维持麻醉并成功进行了手术气管切开术。患者被转移到重症监护室，并在第三天出院。在第五天，鼻内窥镜检查显示，正常脐带会厌最小。气管切开术在第九天被移除，两天后他被出院。病例2一名22岁的女性被送往急诊科，有吞咽困难和口水流涎三天的历史，并从头孢噻肟中进行了分离。耳鼻喉科和美学团队立即对她进行了评估。柔性鼻内窥镜检查显示会厌发炎。她接受了氧气，氢化可的松和头孢噻肟。在手术室中，用100％氧气中的七氟醚吸入诱导后，用气管插管固定她的气道。她被转移到重症监护室，并在那里通风了两天。血液和咽拭子被送去培养。她在第三天拔管并出院。在第五天，柔性鼻内窥镜检查显示会厌有些炎症。第七天她出院了。血培养为阴性。从咽喉拭子中分离出肺炎链球菌，并用头孢噻肟治疗7天。病例3A 33岁的男性出现在急诊科，有发热和流口水四天的病史。他无法打电话。立即给他静脉注射氢化可的松，氧气，外消旋肾上腺素和头孢噻肟。柔性鼻内窥镜检查显示声门上区域肿胀，脐带水肿。在100％氧气中吸入七氟醚诱导后，他在剧院内插管。他被转移到重症监护室，四十八小时后在那里拔管并出院。第五天的柔性鼻内窥镜检查显示会厌正常。从血培养物中分离出流感嗜血杆菌并用头孢噻肟治疗。

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