Bedside ultrasonography as a safe and effective tool to diagnose acute epiglottitis.
Acute epiglottitis is a true airway emergency in the emergency department (ED). The patient may appear very toxic and rapidly progress to respiratory distress and life-threatening condition. The inflammatory process includes not only epiglottis but also the rest of the supraglottic area including the vallecula, aryepiglottic folds, and arytenoids. Soft tissue swelling over this windpipe area can be very dramatic. The criterion standard of diagnosis is direct inspection of cherry red and swollen epiglottis by laryngoscopy in the operation room with immediate access to anesthetists or ear, nose, and throat specialists. However, before the patients are well prepared, the clinical condition may critically go downhill; and any intention to visualize the throat can result in severe and fatal airway spasm. Thumbprint sign on lateral radiography of neck is typical, but it may be extremely risky to let a patient leave the consulting room for the study if respiratory distress has developed. We demonstrate a safe and practical way to investigate the epiglottis by bedside ultrasonography to visualize the "alphabet P sign" in a longitudinal view through thyrohyoid membrane by emergency physician in the ED.
Hung
Tzu-Yao
TY
Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Li
Shang
S
Chen
Po-Shen
PS
Wu
Liang-Ting
LT
Yang
Yuh-Jeng
YJ
Tseng
Li-Ming
LM
Chen
Kuo-Chih
KC
Wang
Tzong-Luen
TL
Hung
Tzu-Yao
TY
D004636:Emergency Service, Hospital; D004826:Epiglottitis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008875:Middle Aged; D019095:Point-of-Care Systems; D011859:Radiography; D014463:Ultrasonography