Acute epiglottitis and Airway Management in Adults

Abstract

Acute epiglottitis, as well as airway management of this malady in adults, can rapidly deteriorate into an airway obstruction. This potential emergency demands prompt evaluation of the epi-glottis with an emphasis on vigilant and proficient attention to airway management. During the examination, the patient should be in a sitting position while under intense observation in preparation for tracheal intubation at any time. For patients affected by respiratory distress, ventilation with 100% O2 and urgent intubation are needed. Choose 1 or 2 sizes smaller than the usual tube sizE for intubation. Oral intubation along with administration of a sedative and muscle relaxant lE comparatively safe and easy. However, in cases where: 1) difficulty in airway establishment is anticipated , 2) SpO2 does not elevate in spite of enough 02 supply, or 3) the patient is already is shock, a sedative or muscle relaxant would precipitate respiratory arrest. In such cases, considei whether oral intubation without a sedative or muscle relaxant or nasal intubation with as endoscope can be performed. Nasal intubation with an endoscope in a sitting position might be effective. For the patient in agony or with difficulty in opening their mouth, intubate after admin-istrating a little amount of sedative while monitoring blood pressure and Sp02. If it is difficult tc establish their airway rapidly, administrate vecuronium and choose oral tracheal intubation whilE being prepared for implementing an emergent tracheotomy, or a cricothyroidotomy; either needle of surgical. If unable to intubate successfully, ventilate with the bag-valve-mask technique with 100% O2 as far as possible, then provide an emergent tracheotomy, needle or surgical cricothyroidotomy immediately. Key words:‹} •« •A"ª ŠW‰Š,‹C "¹ Šm•Û,•¬ •l ‚Í ‚ ¶ ‚ß ‚É ‹} •« •A"ª ŠW ‰Š‚Í ‹} '¬ ‚É •i •s ‚µ ‚Ä •‚ "x ‚Ì ‹C "¹ ‹· •ó ‚ð-ˆ‚½ ‚µ ‚â ‚· ‚¢ Ž¾Š³ ‚Å ‚ ‚è,'v Ž€"I ‚È •a 'Ô ‚É Š× ‚è ‚â ‚· ‚¢.-{ •Ç ‚É 'Î ‰ž‚· ‚é ‚É ‚Í,•a 'Ô ‚ð-•‰ð‚µ ‚½•ã ‚Å,•v '¬ ‚©‚ "K•Ø ‚È‹C "¹ Šm •Û ‚Ì •û-@‚É •K•n ‚· ‚é •K-v‚ª ‚ ‚é.•Å ‹ß,‹} •« •A"ª ŠW ‰ŠŽ€-S-á‚É ‚¨‚¯‚¨‚¯ ‚éˆã‚éˆã-à •Ù"» ‚ª '• ‚¦ ‚Ä‚¢ ‚é.‚± ‚Ì-vˆö ‚AE‚µ ‚Ä,'¼ 'O ‚Ü‚ÅŠ³ ŽÒ‚ª OE³‹C ‚Å ‚ ‚Á‚½‚½ ‚ß ‚ɉAE '° ‚AE‚µ ‚Ä‚Í •S •î "I ‚É "[ "¾ ‚µ ‚ª ‚½‚¢ ‚AE‚¢ ‚Á‚½Š³ ŽÒƒT ƒC ƒh‚Ì-vˆö ‚AE,‹} •« •A "ª ŠW‰Š‚Ì •a 'Ô ‚ð •\ •ª-•‰ð‚µ ‚Ä ‚¢ ‚È ‚¢ˆã‚¢ˆã Žt ‚ª •-‚È ‚-‚È ‚¢,•\ •ª ‚È •à-¾ ‚AE ‹C "¹ Šm•Û ‚Ì •€ "õ ‚ð ‚µ ‚È ‚¢ ‚ÅŽÀŽ{ ‚µ ‚½‰ae 'oeOEŸ •¸ ' † ‚É •a 'Ô ‚ªˆ«‚ªˆ« ‰»‚µ ‚½,•\ •ª ‚È•à-¾‚ð ‚µ ‚È ‚¢ ‚Å‹A'î ‚³ ‚¹ ‚½,‹} •« •A"ª ŠW‰Š ‚Ì ŠÏ Ž@Žè‹Z ‚ð •C "¾ ‚µ ‚Ä ‚¢ ‚È ‚¢ˆã‚¢ˆã Žt ‚ª '½ ‚¢(Ž¨•Ž¨•@ˆô •A‰ÈˆãA‰Èˆã Žt ‚ð •oe ‚-),‹C "¹ Šm•Û Žè‹Z ‚É•K •n ‚µ ‚Ä ‚¢ ‚È ‚¢ˆã‚¢ˆã Žt ‚ª '½ ‚¢,‚È ‚ǂ̈ã‚ǂ̈ã-à ƒT ƒC ƒh‚Ì-vˆö ‚ª •l ‚¦ ‚ç ‚ê ‚é.-{ •e ‚Å ‚Í,•¬ •l ‚Ì ‹} •« •A "ª ŠW‰Š‚É 'Î ‚· ‚é ƒŠƒXƒNƒ} ƒl •[ ƒW ƒ• ƒ" ƒg‚Ì ‚¤ ‚¿,‹~ ‹}ˆã‹}ˆã ‚Ì-§ •ê ‚© ‚ç ‚Ý‚½ •u ‹C "¹ Šm•Û•v ‚É ‚ ‚¢ ‚Ä•q ‚× ‚é. ‹} •« •A "ª ŠW‰Š ‚Ì ŠCŠO• ¶ OE£•ñ •• •]-ˆ,‰¢ •Ä ‚Å ‚Í •¬ Ž™-á ‚Ì •ñ •• ‚ª '½ ‚© ‚Á ‚½ ‚ª, Haemophilus influenza B vaccine‚Ì •• ‹y ‚É ‚ae ‚è Š³ ŽÒ•" ‚Í OE¸•-‚µ ‚½ ‚AE‚³ ‚ê ‚é1).•Å ‹ß ‚Å‚Í,‰¢ •Ä ‚Å ‚à •¬ •l-á‚Ì '• ‰Á ‚ª •ñ •• ‚³ ‚ê ‚Ä‚¨‚è‚Ä‚¨‚è,Hebert‚ç2)‚Í •¬ •l-Ⴊ71.5%,Frantz ‚ç3)‚Í •¬ •l-Ⴊ65.6%‚AE •ñ •• ‚µ ‚Ä ‚¢ ‚é. ‹C "¹ Šm•Û ‚Ì •û-@‚AE‚µ ‚Ä ‚Í,1970"N 'ã "¼‚Î ‚Ü‚Å ‚Í ‹C ŠÇ•Ø ŠJ ' † •S ‚Å ‚ ‚Á‚½‚ª,‹C "¹ Šm•Û ‚É Žž ŠÔ‚ð-v‚µ "] •á ŠQ‚ª '½ •" "-• ¶ ‚µ ‚½ ‚½‚ß,OE» •Ý ‚Í ‹C ŠÇ'} ŠÇ‚ª ' † •S ‚Å,•¬ •l-á‚Å ‚à50%ˆÈ ‰º ‚Å‚Í ‚ ‚é ‚ª ‹C "¹ Šm•Û ‚ª •K-v‚AE‚³ ‚ê ‚é1).Hebert‚ç2)‚É ‚ae ‚é ‚AE,•¬ •l51-á ‚Ì ‚¤ ‚¿ ‹C ŠÇ'} ŠÇ‚Í20%,‹C ŠÇ•Ø ŠJ ‚Í0%‚Å, •¬ Ž™-á‚Å ‚Í68%‚É ‹C "¹ Šm•Û ‚ð-v‚µ ‚½.Frantz‚ç3)‚Ì •ñ •• ‚Å ‚Í,•¬ •l-á‚Ì9.3%‚É ‹C ŠÇ'} ŠÇ ‚ð,5.4%‚É ‹C ŠÇ•Ø ŠJ ‚ð-v ‚µ ‚Ä ‚¢ ‚é. ‹} •« •A"ª ŠW‰Š‚Ì-{-M• ¶ OE£•ñ ••-{-M‚Å ‚Í ‰¢ •Ä ‚AEˆá ‚¢,•¬ •l-á‚Ì •ñ ••4•`10)‚ª 'å •" •ª ‚Å ‚ ‚é(•\1).•Å ‹ß ‚Ì •ñ ••4•`7)‚Å ‚Í,•¬ •l-á‚Å‹C "¹ Šm•Û ‚ð-v •_ OEË'å Šw'å Šw‰@ˆãŠw‰@ˆã ŠwOEnOE¤‹ † ‰È •Ð ŠQ‹~ ‹}ˆã‹}ˆã Šw•ª-ì