Acute epiglottitis

[2ndyear]

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This is a great article about a rare diagnosis that we all learn about, but rarely see, acute epiglottitis. Anyone ever see a case? I have not.

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/19/AR2008091903393.html

 

[pgg]

This is a great article about a rare diagnosis that we all learn about, but rarely see, acute epiglottitis. Anyone ever see a case? I have not.

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/19/AR2008091903393.html

Saw that article a couple days ago. Kind of makes you wonder about a doctor who admits he "lucked into" diagnosing a stridorous, dysphagic, forward leaning, febrile patient with epiglottitis, even if she was an adult.

 

[RickKane]

I saw a 60 something Hispanic male in July during my first rotation as an intern. Good thing the MICU attending had the smarts to call trauma anesthesia to tube the guy. He came in with stridor you could hear from across the room.

 

[Planktonmd]

This is a great article about a rare diagnosis that we all learn about, but rarely see, acute epiglottitis. Anyone ever see a case? I have not.

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/19/AR2008091903393.html

I have seen it twice in my career one time in a child and one time in an adult.
We don't see it in children anymore thanks to the HIB vaccine.
In adults it tends to be less dramatic and caused by bacteria other than H influenza.

 

[oldbearprofessor]

This is a great article about a rare diagnosis that we all learn about, but rarely see, acute epiglottitis. Anyone ever see a case? I have not.

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/19/AR2008091903393.html

I trained in pediatrics before the HIB vaccine. This was a relatively common situation and we had a protocol at the time to "stat" page anesthesia and look at the epiglottis in the OR with ENT/pedi surg. The trick was figuring out when to call this emergency and when it was just viral croup. 95% of the time it was viral and no big deal, but we certainly saw the real thing several times a year.

One of many diagnosis now long-gone in pediatrics. Heck, I'm not sure anyone can recognize chicken pox anymore.😉

 

[usnavdoc]

Saw it once as a pre-med when I used to work in the MICU at vanderbilt. One of the fellows explained it to me then. Didnt know enough at the time to appreciate it though.

 

[pgg]

Heck, I'm not sure anyone can recognize chicken pox anymore.😉

Easy, it looks a lot like smallpox. 🙂

 

[SaintFrances]

We just discharged a 35 y/o AA female after a 10-day stay in the ICU with "Acute Viral Epiglottitis" as the final diagnosis. We looked for everything else as the cause first - she even had ENT take a biopsy of her aretynoids. We never isolated a pathogen or found any other cause for the swelling. She was on the vent for 9 days due to all the edema, having failed several "true" leak tests right up till day 9.

Her only symptom which began 2 days before presenting to the ER with severe respiratory distress was "a sore throat."

 

[Planktonmd]

Easy, it looks a lot like smallpox. 🙂

No, actually it doesn't:
Chickenpox: Lesions at different stages of healing and progress in different areas of the body.
Smallpox: All lesions at a certain part of the body are at the same stage (all of them are papules or vesicles or... but not a mixture).

 

[oldbearprofessor]

No, actually it doesn't:
Chickenpox: Lesions at different stages of healing and progress in different areas of the body.
Smallpox: All lesions at a certain part of the body are at the same stage (all of them are papules or vesicles or... but not a mixture).

I was vaccinated (vaccinia vaccine...) against smallpox in the last wave in which it was given in the 50's.

Cool, I've turned the anesthesia forum into a discussion of pediatrics!

Enjoy!

 

[Planktonmd]

I was vaccinated (vaccinia vaccine...) against smallpox in the last wave in which it was given in the 50's.

Cool, I've turned the anesthesia forum into a discussion of pediatrics!

Enjoy!

I have the scar on my arm as well.
By the way, we always love to have input from experienced pediatricians so feel free to teach us a thing or two when you can.

 

[pgg]

No, actually it doesn't:
Chickenpox: Lesions at different stages of healing and progress in different areas of the body.
Smallpox: All lesions at a certain part of the body are at the same stage (all of them are papules or vesicles or... but not a mixture).

Yes, yes, yes, the point is the lesions themselves look a lot alike. 🙄 Only the staging as you point out is a reliable method for distinguishing the two on exam.

You said that pediatricians are forgetting what chickenpox looks like because of the vaccine, and my joke was that all you had to know was what smallpox looks like (which hasn't been seen in a human in decades) to know what chickenpox looks like. My answer was deliberately factually correct yet practically useless.

It's funny. Laugh.

 

[usnavdoc]

Yes, yes, yes, the point is the lesions themselves look a lot alike. 🙄 Only the staging as you point out is a reliable method for distinguishing the two on exam.

You said that pediatricians are forgetting what chickenpox looks like because of the vaccine, and my joke was that all you had to know was what smallpox looks like (which hasn't been seen in a human in decades) to know what chickenpox looks like. My answer was deliberately factually correct yet practically useless.

It's funny. Laugh.

Dont worry dude, I got your joke. BTW did you ever get vaccinated for smallpox before going over? What a waste and a needless exposure risk that was.

 

[Planktonmd]

Yes, yes, yes, the point is the lesions themselves look a lot alike. 🙄 Only the staging as you point out is a reliable method for distinguishing the two on exam.

You said that pediatricians are forgetting what chickenpox looks like because of the vaccine, and my joke was that all you had to know was what smallpox looks like (which hasn't been seen in a human in decades) to know what chickenpox looks like. My answer was deliberately factually correct yet practically useless.

It's funny. Laugh.

🙂
Hey, don't be so sensitive, it was a great joke.

 

[kmurp]

I have seen 4 cases in 20 years. The first was almost 20 years ago in an infant of about 12-13 months. I'm glad I was young then... The others were all adults including an elderly guy with a number of significant cardiac issues who was recovering from thoracic surgery 1 mo. prior. I remember being confused as to the best approach for him as a Halothane induction didn't seem like a good idea for his heart but was ( I had been taught) the best way for his airway. In the end, I went with the airway induction as this was the guys acute, possibly fatal, problem.
The last case I saw was my partners. He wisely called me in late one evening to help with the case. Not that I'm so great but it just helps to have help on these - they're scary.