Use of a Tracheal Tube as a Nasally Inserted Supraglottic Airway in a Case of Near-Fatal Airway Obstruction Caused by Epiglottitis
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Abstract:
Airway management is critical during near-fatal obstruction of the upper airway in epiglottitis; however, this is challenging because of the sitting posture and agitated mental status of the patient. Moreover, there is currently no established protocol for safe airway management in patients with epiglottitis. Here, we describe the use of a conventional tracheal tube as a nasolaryngeal airway to maintain airway patency at the site of airway narrowing in the supine position, which enabled alleviation of imminent airway obstruction in a patient with epiglottitis. For definitive airway establishment, tracheostomy was then safely performed in the supine position.Keywords:
Supine position
Epiglottitis
Airway obstruction
Epiglottis
Tracheotomy
A previously healthy 65-year-old woman presented with a 7-day history of throat pain, difficulty swallowing, muffled voice, and fevers. Lateral soft-tissue radiography of the neck showed the “thumb sign,” indicating a swollen epiglottis, suggestive of epiglottitis.
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Abstract Acute epiglottitis is an acute inflammatory condition of the epiglottis, arytenoids, and aryepiglottic folds, with gross swelling and oedema of the structures at the laryngeal inlet, resulting in an acute upper airway obstruction. The onset and progression of symptoms are rapid and can lead to complete upper airway occlusion, hypoxaemia, and death. Acute epiglottitis is a medical emergency and requires prompt recognition and management.
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Epiglottitis
Airway obstruction
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Graphical Abstract Emphysematous epiglottitis is a rare manifestation of epiglottitis wherein free air accumulates within the epiglottis, potentially leading to rapid upper airway obstruction. Physicians should be familiar with the diagnosis and treatment of this life-threatening condition.
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Epiglottitis
Airway obstruction
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Epiglottis
Epiglottitis
Airway obstruction
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Epiglottitis is the inflammation of the epiglottis and adjacent supraglottic structures. Early recognition of specific symptoms, as well as the systemic signs of sepsis, can help prevent serious complications. A good understanding of the steps in the management of the condition aids early intervention and treatment. The priority of treatment is to secure the airway. Serious complications can occur in addition to the severity of the disease. Symptoms can be more prolonged depending on the aetiology. If the epiglottis is still swollen after 72 hours of treatment, then further investigation should be carried out.
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We report a case of a 31-year-old Japanese woman with an uncommon shape of epiglottis misleading as acute epiglottitis. She presented with high fever, arthralgia, general fatigue and strong throat pain. Laryngeal fiberscopy showed a markedly swollen epiglottis suggestive of acute epiglottitis, though she had no signs of asphyxia. A careful observation and detailed medical history ruled out acute epiglottitis. However, without clinical discretion, it might have been misinterpreted as acute epiglottitis. She was diagnosed later with Behçet's disease, which is reported to present pharyngeal stenosis. Two years later, a repeat laryngeal fiberscopy showed exactly the same appearance of the epiglottis, suggesting its shape to be permanent. The cause of this misleading shape of the epiglottis in this patient is yet unknown. For similar cases, a possibility of this kind of epiglottis should be considered before diagnosing as acute epiglottitis.
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Acute epiglottitis is an inflammation of the epiglottis and adjacent structures. Although the incidence is extremely rare, acute epiglottitis is a life-threatening medical emergency and can cause sudden respiratory obstruction. Herein, we describe two cases of sudden death from epiglottitis and epiglottic abscess. A 39-year-old man and 66-year-old man died after suffering from shortness of breath. Autopsies revealed diffuse swelling and abscess formation in the epiglottis and neighboring structures. These cases emphasize the medicolegal importance of sudden death from acute epiglottitis and epiglottic abscess in adults.
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In the past decade, changes have occurred in the management of epiglottitis. A ten-year retrospective study of 64 patients admitted to the Children's Hospital of Philadelphia with the diagnosis of epiglottitis was performed. An evolution in the management of epiglottitis was demonstrated in this series of patients. The morbidity and mortality of currently employed modes of airway management (medical observation, endotracheal intubation or tracheostomy) were compared. There were no deaths in the series. Endotracheal intubation had a lower rate of complication than treatment with tracheostomy. A small, select group was conservatively managed with close observation. The use of antibiotics and steroids was analyzed. Suggested guidelines for management of epiglottitis are presented.
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Endotracheal intubation
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