Acute epiglottitis in the adult

GPs are often the first to see adults with acute epiglottitis, yet the information on how to treat them is not usually available. The seven cases presented here demonstrate a wide spectrum of severity with characteristic signs and symptoms. Diagnosis and management are discussed.     

Acute epiglottitis in the adult

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.     

Simultaneous uvulitis and epiglottitis in adults

The emergency physician must be aware of the varied ways in which epiglottitis can present. This report discusses two adult patients who presented with symptoms and signs indicative of uvulitis who were found to have associated epiglottitis. Neither patient reported respiratory difficulty but both experienced significant pain upon swallowing and were febrile with an enlarged, erythematous uvula. Management consisted of close observation and treatment with an intravenous antibiotic and corticosteroid. The emergency physician should consider the possibility of coexistent epiglottitis in the adult patient who presents with uvulitis.     

Acute Hemophilus parainfluenzae epiglottitis in an adult

A 60-year-old man, who had non-insulin-dependent diabetes but was otherwise in good health, was hospitalized for sudden upper airway obstruction and respiratory arrest. Findings on fiberoptic laryngoscopy were consistent with acute epiglottitis. Blood cultures and factor analysis later revealed that the responsible pathogen was Hemophilus parainfluenzae. Acute epiglottitis in the adult is no longer considered rare and is usually attributed to H influenzae. The case described here and two other cases reported elsewhere indicate that H parainfluenzae may also be a cause of this serious and often fatal infection of the upper respiratory tract.     

纤维支气管镜用于成人喉罩定位的临床研究

目的探讨常规喉罩插入法喉罩理想位置的到位率,提高喉罩通气技术的安全性。方法采用纤维支气管镜(fiberoptic bronchoscope,FOB)对127例使用喉罩通气全麻的成年患者,验证喉罩插入位置的到位率,对插入喉罩位置不理想者在FOB直视下进行调整。结果常规喉罩插入法到位率为76.37%,经FOB直视下调整喉罩后所能达到1级者较之调整前明显增加(P<0.05);插入喉罩位置不当(位置分级≥2级)原因主要为深度不适宜。结论采用FOB对喉罩定位是一种准确、安全的方法,可以显著提高喉罩插入的到位率。     

The early management of acute epiglottitis: a survey of current practice

Although the importance of proper management of acute epiglottitis has been well recognized, little attention has been paid to the vulnerable period of time before the patient reaches the hospital. The courses of 23 children with acute epiglottitis were reviewed to determine prehospitalization management and morbidity.     

成人急性会厌炎45例临床分析

目的：总结成人急性会厌炎的治疗方法。方法：回顾性分析我科2000年1月至2011年12月收治的成人急性会厌炎45例的临床资料。结果：45例均用抗生素及糖皮质激素治疗，44例行保守治疗痊愈，1例紧急气管切开，45例均痊愈。结论：成人急性会厌炎治疗的关键是及早诊断、维持呼吸道通畅、使用敏感抗生素和糖皮质激素。     

Acute epiglottitis after COVID‐19 infection

In patients with acute epiglottitis, the possibility of COVID‐19 should be ruled out. Repeated nasofiberoscopy examinations or a tracheostomy, which may produce infectious aerosols, may be required.     

Acute epiglottitis: a different approach to management

Between January 1979 and October 1986, 349 patients with epiglottitis were admitted to the Royal Children's Hospital, Melbourne, Australia. Forty-five (13%) patients were not intubated, 291 (83%) were managed by nasotracheal intubation and spontaneous respiration without sedation, three (1%) received continuous positive airway pressure, and ten (3%) were ventilated. The 294 patients who were not ventilated were intubated for a mean of 18 +/- 9.5 (SD) h; 90% were extubated within 24 h. Criteria for extubation included resolution of fever (less than 37.5 degrees C), passage of time (12 to 16 h), and improvement in the general appearance of the child. Laryngoscopy was not performed before extubation. Providing there is always a doctor present who can reintubate if accidental extubation occurs, routine use of sedation, paralysis and mechanical ventilation, and pre-extubation laryngoscopy are not required for the management of children with uncomplicated epiglottitis, and their use may prolong the period of intubation.     

正常成人空腹幽门管声像图

目前"充盈型胃超声"为多数学者所认同,但其在上消化道急腹症的应用受到一定限制[1].本文观察正常成人空腹幽门管正常声像图,旨在拓宽空腹胃超声的应用范围.     

成人气管和支气管异物的诊治

目的 探讨成人气管支气管异物的临床特点以及诊治.方法 回顾性分析我院1996年1月至2010年1月收治的24例成人气管支气管异物的病例资料,其中男16例,女8例,年龄18~85岁.结果 成人气管支气管异物种类多样,临床表现各异,容易漏诊,其中有1例漏诊长达7年之久.24例中,有10例行硬质支气管镜下取出异物;7例纤维支气管镜下取出异物;3例患者入院后自行咳出异物;1例在支撑喉镜下取出异物;1例急诊行气管切开异物取出术;共治愈22例,死亡2例.结论 成人气管支气管异物少见,临床表现各异,容易误诊.绝大多数成人气管和支气管异物可通过纤维支气管镜或硬性气管镜处理而痊愈.     

成人麻疹42例临床分析

目的加深对成人麻疹的认识,对常规治疗方法提出改进。方法回顾分析42例成人麻疹的临床资料。结果42例患者均表现高热,18例前驱期延长,32例为多皮疹组,10例为少皮疹组,合并咽峡炎42例,支气管肺炎26例,肝损害20例,肾损害7例,病毒性心肌炎8例,腹泻9例,胃肠道出血2例。多皮疹组易合并支气管肺炎,少皮疹组易合并肝肾功能障碍。治疗方法除了常规抗病毒、抗感染及支持疗法外,给予维生素A200,000IU/d顿服,连续2天。结论成人麻疹病情严重,合并症多,表现不典型,需认真鉴别及治疗,合理应用维生素A可以降低病死率及肺和胃肠并发症。