People often remark to me, 'Wah working in emergency department must be very exciting! I bet you gets to see lots of gory injuries and things people 'accidentally' stick up their various orifices!'

Don't worry, you won't be seeing any of those. :)

What you WILL see, however, are interesting photos, ECGs, Xrays etc. which serve to remind us of the vast variety of cases that may come our way, and some of the learning points behind them.

Enjoy. :)


Tuesday, April 5, 2011

Case 11


30 year old male

The 10th case of fever and sorethroat you've seen tonight. Why can't they come during the office hours ?!?!

Answer : Acute Epiglottitis

  • taught in medical school under paediatrics, but is actually 2-3 times more common in adults
  • common pathogen : Haemophilus influenzae, B-hemolytic strep
  • classical presentation of drooling child with tripod stance may not be seen in adults, who commonly present with sorethroat, odynophagia, muffled voice
  • unlike in children, emergent airway mx usually not an issue in adults due to larger diameter of airway; however be careful if there is stridor
  • Xray - classical 'thumb sign'; FBC - white cell count > 10,000 in 80% of cases
  • Management key : (1) Admit for close airway monitoring KIV intubation, (2) IV antibiotics (Ceftriaxone, Cefotaxime, Ampicillin/ Sulbactam). Steroids are commonly used but no randomised trials.
Posted by Sentinel at 11:33 PM
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2 comments:

  1. AnonymousMay 26, 2011 at 10:26 PM

    good read ..
    http://www.medscape.com/viewarticle/717927

    ReplyDelete
  2. SentinelMay 27, 2011 at 11:26 AM

    Anonymous - Great article with pearls of wisdom distilled from long ED experience - thanks for sharing! :)

    ReplyDelete

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