BOF:
24
A 21
year old male presents with a history of sore throat, pain on swallowing and a
muffled voice. Apart from a upper respiratory tract infection a few days prior
to the onset of these symptoms, he had been well and was not on any
medication. He did not smoke but drank 24 units of alcohol per week.
On
examination he was febrile, there was drooling of saliva from his mouth, there
was no tonsillar enlargement. He had a pulse rate of 110 beats per minute,
there was cervical lymphadenopathy and tenderness over the larynx. His
respiratory rate was 30 per minute and you could hear stridor
In
this patient which one of the following organisms is most likely to have
caused the condition?
a)
Haemophilus influenzae type B
b)
Pneumococci
c)
Group A beta-haemolytic Streptococcus
d)
Pseudomonas
e)
Mycobacterium tuberculosis
Answer: a)
The
clinical features suggest the patient has epiglottitis
Epiglottitis
ü
Acute
inflammation in the supraglottic region of the oropharynx
ü
Inflammation of the epiglottis, vallecula, arytenoids and aryepiglottic folds
Clinical Features
History
ü
Sore
throat
ü
Odynophagia / dysphagia
ü
Muffled voice
ü
Mild
cough
ü
Usually, no prodromal symptoms in children
ü
Adults
may have preceding upper respiratory infection (URI) symptoms.
Examination
ü
Tripod
position (Sitting up on hands with the tongue out and the head forward)
ü
Fever
ü
Toxic
appearance of patient
ü
Irritability
ü
Drooling/inability to handle secretions
ü
Severe
pain on palpation over the larynx
ü
Cervical lymphadenopathy
ü
Stridor (late finding indicating advanced airway obstruction )
ü
Respiratory distress
ü
Tachycardia
Causes
ü
Haemophilus influenzae type B (most common)
ü
Pneumococci
ü
Group
A beta-haemolytic Streptococcus
ü
Pseudomonas
ü
Mycobacterium tuberculosis
ü
Viruses
ü
Local
trauma (inhalation of foreign bodies or post intubation)
Revision Tip
Revise
causes of stridor ACES for PACES page
257-258
