At the scene, just a few minutes ago, the emergency doctor opened the X-ray of the patient's neck. At a glance, the otolaryngologist saw the chilling "that praise" deep in the patient's throat.
The patient, Mr. Ke, sat in the hospital bed with a painful expression and a cold sweat. Even though he wears an oxygen mask, he still feels difficult to breathe. When he inhales, he gives out a high-frequency gasp.
Doctor, I have a sore throat ... I can't swallow anything ... and ... I have a fever today ... and my breathing is getting worse. ...
The otolaryngologist frowned and quickly examined Mr. Ke's throat with an endoscope. Sure enough, he saw a picture that worried him.
"You this is acute epiglottitis, and respiratory tract has been blocked by more than half, the situation is quite critical! It is suggested that intubation is needed to protect the respiratory tract. If the cannula cannot be inserted, a tracheotomy is needed. 」
After listening to the doctor's explanation, Mr. Ke, his wife and children were stunned by the seriousness of the situation. His wife almost cried the moment she was informed of her critical illness.
Soon, the anesthesiologist also came. Patients who encounter this kind of "difficult intubation" in the hospital have to rely on experienced anesthesiologists and use special instruments to intubate. At this time, otolaryngologists are usually on the side, armed to the teeth, and when all intubation methods fail, they need to carry out "gas cutting" as the last resort to save lives.
Fortunately, after some efforts, I finally helped Mr. Ke pull out the endotracheal tube from his nose. Although the process is difficult, at least I can breathe smoothly. Then transferred to the intensive care unit for follow-up treatment.
What is epiglottis? Why is epiglottis so terrible?
Epiglottis is a piece of cartilage in the throat, located deep behind the tongue. In general, it is very thin and looks like a leaf from above. It has an important function, that is, when we swallow, it covers the trachea entrance backwards to prevent food from running to the respiratory tract and causing choking or suffocation. When this thin cartilage swells for some reason, it is easy to block the respiratory tract and cause difficulty in breathing because it is located above the trachea. If the epiglottis is too swollen and occupies the space above the tracheal entrance, it will lead to the difficulty or even failure of intubation, which is life-threatening.
A more appropriate name for this disease should be "acute supraglottitis". Glottis is the tracheal entrance near the vocal cords. There are other structures (such as arytenoid cartilage and laryngeal mucosa). ) above, it may be inflamed and swollen, causing sore throat or dyspnea. However, acute epiglottitis is the most famous and common.
Why is epiglottis inflamed?
Both adults and children may develop acute epiglottitis. Bacterial infection is the most common cause of acute epiglottitis. Others, including allergic reaction, edema after electrotherapy and so on. , can also cause epiglottitis.
There are many bacteria that can cause acute epiglottitis. In the past, Haemophilus influenzae type B was the most notorious and common, and other bacteria included Streptococcus pneumoniae and Staphylococcus aureus.
However, since the inoculation of Haemophilus influenzae type B vaccine, the probability of children suffering from acute epiglottitis has dropped a lot. At present, children aged 6 to 12 are more common. Adult acute epiglottitis maintains a certain incidence. According to foreign reports, acute epiglottitis mainly occurs in adults aged 40-50, especially men. Horribly, about one in every 100 adults suffering from acute epiglottitis will die seriously! Therefore, we must not ignore this disease.
What are the symptoms of acute epiglottitis?
Most adult patients with acute epiglottitis will have symptoms of sore throat and swallowing pain. In addition, they may have difficulty swallowing saliva, fever, hoarseness, breathing and wheezing. Mr. Ke is a serious case, because sometimes epiglottitis will progress quickly, which will cause respiratory obstruction and affect breathing within a few hours.
Compared with adults, children are still in the development stage, with narrow throat space, which is easily blocked by swollen epiglottis and difficult to breathe. It should be noted that children can only express themselves in other ways because they cannot express themselves clearly like adults. Typically, their bodies will take a "tripod posture", that is, they will lean forward, put their hands down, raise their heads, open their mouths and stick out their tongues in order to make the narrow respiratory tract slightly unobstructed. In addition, the child's expression will also appear anxious. Whose illness will be more serious?
Because the disease may progress rapidly and threaten life, many doctors are curious about who will be seriously ill and need special attention.
Foreign studies have found that many patients with acute epiglottitis have diabetes, cardiovascular diseases, respiratory diseases, infectious diseases and so on. Japanese research mentioned that people with old age, male, obesity, diabetes, pneumonia or epiglottis with cysts may have more serious conditions, which require special attention and more active follow-up of respiratory obstruction.
What tests will the doctor do?
Is the sore throat caused by epiglottis or the most accurate sight? However, if epiglottis swelling has caused partial obstruction of the respiratory tract, the examination with tongue depressor may cause vomiting reflex, and even the risk of laryngeal spasm and complete obstruction of the respiratory tract.
In view of this, experienced otolaryngologists will use nasal endoscope to observe epiglottis cartilage, which can not only reduce the risk of examination, but also rule out whether there are other problems at the same time, such as deep neck infection, foreign bodies, tumors and so on.
In addition, the X-ray examination of the side of the neck is also helpful for diagnosis. The typical X-ray performance is to find a thumb sign in the throat, which looks like "praise", but the doctor doesn't feel awesome when he sees this image! How to treat acute epiglottitis?
Because the course of acute epiglottitis may change rapidly, hospitalization is generally recommended. Because most of them are bacterial infections, intravenous antibiotics are needed. You may need to add some water because you have a sore throat and a bad appetite. According to the situation, steroid injection and inhalation drug therapy can help epiglottis to reduce swelling and accelerate recovery.
Another important purpose of hospitalization is that if the patient's respiratory condition changes at any time, it can be detected immediately by using blood oxygen concentration monitor and endoscope, and treated immediately, such as tracheal intubation or tracheotomy, to ensure smooth respiratory tract.
Some epiglottitis will form abscess, making epiglottis like a water polo. If the airway patency is seriously affected, incision and drainage of abscess under laryngoscope under general anesthesia can be considered to help reduce swelling and prevent recurrence.
After drug treatment, if epiglottis has recovered or is close to normal, you can take oral antibiotics and leave the hospital. Most acute epiglottitis can be cured successfully after proper treatment, but we should pay close attention to whether the symptoms recur. If anything goes wrong, you must go back to the clinic as soon as possible.
Never underestimate a sore throat.
After in-hospital observation and drug treatment, two days later, after endoscopic examination, epiglottis cartilage has swollen and returned to normal flake. The endotracheal tube was successfully removed and returned to the general ward for observation for five days. The condition was stable and he was finally discharged home.
With this unforgettable "critical illness" experience, Mr. Ke not only rejoiced that he seemed to be reborn, but also became the best "health care teacher for sore throat", and warned his relatives and friends around him with his own experience: "This kind of sore throat must not wait! 」
On-site screening:
Sore throat, beware of abscess around tonsil!
References:
● Shah RK, stocks C. epiglottitis in the United States: national trends, differences, prognosis and management. Laryngoscope 20 10 jun; 120(6): 1256-62.
● Bizaki AJ, Numminen J, Vasama JP, Laranne J, Rautiainen M acute supraglottitis in Finland *** s: a review and analysis of 308 cases. Laryngoscope 20 1 1 Oct； 12 1( 10):2 107- 13.
● Factors related to severe epiglottitis in Suzuki S, Taiyong H, Matsui H, Fushimi K, yama soba t. * * * S: Analysis of Japanese inpatient database. Laryngoscope 20 15 September; 125(9):2072-8.
● Shapira Galitz Y, Shoffel-Havakuk H, Cohen O, Halperin D, Lahav Y. Adult acute supraglottitis: 358 patients were predicted and analyzed by airway intervention. Laryngoscope 20 17 September; 127(9):2 106-2 1 12.