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ʻO nā maʻi ʻāʻī hohonu, Ludwig's Angina, a me Peritonsillar Abscess Triage

He ʻokoʻa nā helu ulia pōpilikia ma ka ʻāina. Hoʻohana kēia ʻaoʻao i ka 911, ka helu no ʻAmelika a me Kanada. Nui nā ʻāina ʻē aʻe i hoʻohana i ka 112, 999, a i ʻole ka helu ʻē aʻe. E huli i ka helu no kou ʻāina.

Aia ma lalo o ka ʻili o ka ʻāʻī, ka papahele waha, a me ka ʻāʻī he labyrinth paʻakikī o nā keʻena anatomical i hoʻokaʻawale ʻia e nā papa paʻakikī o ka fascia cervical hohonu. Ke komo mai ka ma'i bacteria mai ka ma'i niho mola ha'aha'a i lapaau ole ia, ka tonsillitis ko'iko'i, ka iwi i'a pharyngeal, a i 'ole ka ma'i kohu kohu i komo i loko o keia mau hakahaka, laha koke ka na'u a me ka pehu ma ke ala o ke ku'e. No ka mea, ua hoʻopaʻa ʻia kēia mau ʻāʻī hohonu e ka iwi ʻoʻoleʻa (ka iwi kuamoʻo a me ka iwi kuamoʻo) a me nā puʻu fascial paʻa, ʻaʻole hiki ke hoʻonui maʻalahi i ka pehu a me ka edema; akā, ʻoki lākou i ke ea o luna i loko, hoʻokuʻu i ke alelo i luna i ke kaupaku o ka waha, a i ʻole e hele pololei i lalo i loko o ka lua o ka umauma (descending necrotizing mediastinitis).

ʻO nā maʻi ʻehā o ka ʻāʻī hohonu a me ka pharyngeal ʻo Ludwig's angina (he cellulitis bilateral e laha wikiwiki nei o ka papahele o ka waha), ** peritonsillar abscess a i ʻole "quinsy" ** (he ʻeke pus ma hope o hoʻokahi tonsil), retropharyngeal abscess (he abscess ma hope o ka paia hope o ka ʻāʻī e hiki ke hoʻokahe i ke koko i loko o ka umauma**), a hiki ke hoʻokahe pono i ke koko i loko o ka ʻāʻī. jugular vein). ʻO ka ʻike ʻana i nā hae ʻulaʻula nui o ka hoʻouka ʻana i ka ʻāʻī hohonu, e like me ka pehu ʻana o ka lāʻau, e like me ka papa ma lalo o ka ʻauwae, kahi alelo hoʻokiʻekiʻe kiʻekiʻe, hiki ʻole ke wehe i ka waha ma mua o ʻelua manamana lima ākea (trismus), kahi uvula i hoʻokuʻu ʻia, a me ka drooling, hiki iā ʻoe ke mālama i ka mea maʻi e noho pololei a hoʻāla ʻia ma mua o ka hoʻōla ʻana i ka ea.

E hana i kēia i kēia manawa

  1. **E kāhea koke i kāu helu ulia pōpilikia inā loaʻa ka pehu ma lalo o nā ʻaoʻao ʻelua o ka ʻauwae a i ʻole ka ʻeha ʻeha o ka ʻāʻī, hoʻokuʻu ʻia ke alelo i luna i luna o ka waha, drooling, leo puʻupuʻu "hot potato", a i ʻole ka hanu ʻana (stridor). Australia, a i ʻole e nānā i ka papa kuhikuhi o helu pilikia.
  2. **E hoʻomau i ka mea maʻi e noho pololei a hilinaʻi iki i mua no laila e huki ka ʻumekaumaha i ke kumu alelo pehu a me ka kohu mai ka ʻūhā makani. ʻO ka moe palahalaha e hiki ai i ke kumu pehu a koʻikoʻi o ke alelo ke hāʻule i hope i ka paia pharyngeal hope, hiki ke hoʻopau koke i ke ala ea.
  3. ** MAI ho'āʻo e paʻi, ihe, ʻomi, a i ʻole e hoʻoheheʻe i ka ʻāʻī i pehu ʻia, a i ʻole ka pehu ʻāʻī ma ka home. ʻO ka ʻō ʻana i ka nila a i ʻole ka pahi i loko o ka ʻāʻī e pehu ana ma waho o ka haukapila hiki ke hou i ke aʻa carotid, hoʻokuʻu pololei i ka nahu i loko o ka māmā, a i ʻole ke kumu o ka laryngospasm make.
  4. E mālama pono i ka mea maʻi i ka NPO (ʻaʻohe mea ma ka waha) a hāʻawi iā ia i ke kāwele a i ʻole ke kīʻaha e kuha aku ai i ke kohu. Mai noi iā lākou e ale i ka wai, wai paʻakai kumu, a i ʻole nā ​​​​lāʻau ʻeha waha inā e lohi a pehu paha i lalo o ka waha. Pono paha ka mea maʻi i ka hoʻokahe ʻana i ka wai hoʻokalakupua a i ʻole ke ala ʻana i ka fiberoptic intubation i loko o ka haukapila, e pono ai ka ʻōpū ʻole.
  5. E hana i ka "Two-Finger Trismus Check" me ka ʻoluʻolu me ka ʻole e hoʻokaʻawale i ka ʻāwae. E noi i ka mea maʻi inā hiki iā lākou ke hoʻokomo mālie i ʻelua a ʻekolu paha o kā lākou mau manamana lima i hoʻopaʻa ʻia ma waena o ko lākou mau niho mua a lalo. Inā ʻaʻole ʻo ka spasm aw (trismus) i ka wehe ʻana i ka waha a hiki i 2 kenimika (0.8 iniha, a i ʻole ʻelua mau manamana lima), ua komo ka maʻi i nā ʻiʻo masticator a koi ʻia ke komo koke ʻana i ka haukapila.
  6. **E wehe koke i nā lei paʻa, nā kaulahao, a i ʻole nā ​​pālule i koli ʻia a e ʻimi i ka palena o waho o ka ʻulaʻula a i ʻole ka pehu ʻana me ka peni, e ʻike i ka manawa pono. ʻO ka mākaʻikaʻi ʻana i ka palena ʻili e kōkua i nā kauka pilikia e ʻike i ka wikiwiki o ka hele ʻana o ka maʻi i lalo i ka ʻāʻī a me ka umauma.

No ke aha ʻo Ludwig's angina kahi pilikia ea ma mua o ka hoʻomaka ʻana o ka stridor

ʻO ka huaʻōlelo * angina * mai ka Latin * angere * a me ka Helene * ankhone * , ʻo ia hoʻi, "e ʻoki a ʻoki ʻia." I loko o Ludwig's angina, ʻo ka maʻi bacteria polymicrobial mai kahi maʻi ʻē aʻe a i ʻole kolu o ka niho mola i hoʻopili ʻia i nā ʻaoʻao ʻelua o ka papahele o ka waha (nā hakahaka sublingual a submandibular). Ma muli o ka palena o ka papahele o ka waha ma lalo e ka maʻa muscular o ka ʻiʻo mylohyoid a hoʻopuni ʻia e ka kāmaʻa lio ʻoʻoleʻa o ka iwi āwae haʻahaʻa (mandible), ʻelua wale nō ʻaoʻao e hoʻonui ai i ka edema brawny e hōʻiliʻili wikiwiki ana: ** i luna a i hope **. Hoʻokuʻu ʻo ia i ke alelo o ka mea maʻi i luna i ka palaka paʻa a hoʻihoʻi pololei i ke kumu o ke alelo i ka hypopharynx. ʻOi aku ka pōʻino, paʻa ʻo trismus i ka ʻāwae i ka wā e hoʻopiha ai ke alelo pehu i ka lua waha holoʻokoʻa, ʻaʻole hiki ke hoʻokomo ʻia ka waha-a-tube maʻamau inā hopu ka mea maʻi. E lawe pololei i ka hoʻomaka ʻana o ka pehu ʻana o ka submandibular bilateral a i ʻole ka piʻi ʻana o ke alelo.

ʻO ka lāʻau hoʻoholo pilikia no ka ʻāʻī koʻikoʻi, nā niho, a me nā maʻi ʻāʻī hohonu

flowchart TD
    Start["Severe Sore Throat, Lower Molar Tooth Pain, or Neck Swelling with Fever"]
    AirwayCheck{"Are ANY Immediate Airway or Ludwig's Angina Red Flags Present?<br/>- Bilateral woody/board-like swelling under the chin ('Bull Neck')<br/>- Floor of mouth swollen or tongue pushed up/out of mouth<br/>- Drooling saliva / unable to swallow own spit<br/>- Audible stridor (high-pitched breathing) or sitting in Tripod posture"}
    LudwigProtocol["CRITICAL DEEP NECK AIRWAY EMERGENCY (LUDWIG'S ANGINA / RETROPHARYNGEAL)<br/>1. Call EMS (911 / 112 / 999) immediately for ALS surgical hospital transport<br/>2. Keep patient sitting 100% UPRIGHT leaning slightly forward<br/>3. NEVER lay patient flat on their back<br/>4. Keep strictly NPO; provide basin/towel for drooling saliva<br/>5. Remove neck jewelry; mark border of neck swelling with pen and time"]
    TrismusQuinsyCheck{"Are Peritonsillar Abscess (Quinsy) or Deep Space Signs Present?<br/>- Severe ONE-SIDED throat and ear pain<br/>- Trismus: Cannot open mouth 3 fingers wide (jaw locked)<br/>- Muffled 'Hot Potato' voice<br/>- Uvula pushed across to the opposite side of the throat<br/>- Stiff neck / pain moving neck backward or sideways"}
    AbscessProtocol["URGENT DEEP NECK / PERITONSILLAR ABSCESS TRIAGE<br/>1. Arrange immediate Emergency Department transport (call EMS if drooling or weak)<br/>2. Keep patient sitting upright and strictly NPO (nothing by mouth)<br/>3. DO NOT attempt to lance or squeeze the swollen tonsil<br/>4. Hospital ENT team will perform needle aspiration/drainage & IV antibiotics"]
    SepsisJugularCheck{"Are Lemierre's Syndrome / Jugular Thrombophlebitis Signs Present?<br/>- Tender, swollen cord along one side of the neck (anterior to sternocleidomastoid)<br/>- High spiking fevers with shaking chills (rigors) days after a sore throat<br/>- Shortness of breath or pleuritic chest pain (septic lung emboli)"}
    LemierreProtocol["SUSPECTED LEMIERRE'S SYNDROME / DEEP NECK SEPSIS<br/>1. Immediate Emergency Department evaluation for CT neck with contrast & IV antibiotics<br/>2. Monitor for septic shock (rapid heart rate, confusion, pale/mottled skin)"]
    SimplePharyngitis["UNCOMPLICATED PHARYNGITIS / TONSILLITIS OR LOCAL DENTAL CARIES<br/>(Mouth opens > 3 fingers wide, uvula midline, floor of mouth soft,<br/>swallows saliva & liquids without drooling, neck moves freely)<br/>1. Seek same-day medical or dental clinic evaluation<br/>2. Re-check every 2 to 4 hours for trismus, drooling, or submandibular swelling"]

    Start --> AirwayCheck
    AirwayCheck -->|Yes: Airway / Floor-of-Mouth Signs| LudwigProtocol
    AirwayCheck -->|No: Floor of Mouth Soft, No Stridor| TrismusQuinsyCheck
    TrismusQuinsyCheck -->|Yes: Trismus, Shifted Uvula, or Stiff Neck| AbscessProtocol
    TrismusQuinsyCheck -->|No| SepsisJugularCheck
    SepsisJugularCheck -->|Yes: Lateral Neck Cord + Rigors| LemierreProtocol
    SepsisJugularCheck -->|No| SimplePharyngitis

Ka hoʻohālikelike ʻana i nā maʻi ʻāʻī hohonu a me nā abscesses pharyngeal

ʻO ka hoʻomaopopo ʻana i ka ʻāpana anatomical i loaʻa i ka maʻi e wehewehe i ke kumu o kēlā me kēia maʻi e hoʻopuka ai i kahi ʻano ʻokoʻa o ka laka ʻana o ka iwi āpau (trismus), ka neʻe ʻana o ke alelo, ʻoʻoleʻa ʻāʻī, a i ʻole ka ʻeha o ka umauma.

Kūlana Kālā Hoʻokomo ʻia ka Anatomical Space Ke kumu maʻamau / hoʻomaka Nā hōʻailona kino a me ka ʻike maka ʻO ka hoʻopiʻi make mua
Ludwig's Angina Nā ʻAha ʻaoʻao ʻokoʻa, ʻĀpana Sublingual, a me Submental Spaces (papa holoʻokoʻa o ka waha) Odontogenic (80% a 90%): ʻO nā aʻa maʻi o ka mau mola 2 a i ʻole 3 lalo (nā niho akamai) e hōʻalo ana ma lalo o ka laina mylohyoid Ka pehu like me ka papa "woody" ma lalo o ka auwae ("Bull Neck"); hoʻokiʻekiʻe ka papahele o ka waha; kuʻi ʻia ke alelo i luna a i waho; trismus nui, drooling, tripod posture ** ʻO ka asphyxiation holoʻokoʻa ** mai ka neʻe ʻana o ke alelo hope a me ka edema supraglottic; hiki ole ke intubate ma o ka waha
Peritonsillar Abscess ("Quinsy") Loaʻa ka hakahaka ma waena o ka palatine tonsil capsule a me ka ʻiʻo constrictor pharyngeal kiʻekiʻe (kokoke mau ʻaoʻao unilateral) ʻO ka hoʻopiʻi ʻana o ka tonsillitis bacterial a i ʻole pharyngitis (a i ʻole ka maʻi liʻiliʻi o Weber salivary gland); makahiki kiʻekiʻe 15 a 40 makahiki Ka ʻeha ʻeha ʻaoʻao hoʻokahi me ka ** ʻeha pepeiao (otalgia)** ma ka ʻaoʻao hoʻokahi; trismus (āwae laka); leo leo "Hot Potato"**; pehu ka ʻāʻī palupalu e hoʻokuke ana i ka uvula ma kahi ʻaoʻao ʻO ka ʻāhaʻi ʻana o ka ʻōpū me ka manaʻo o ka pus i loko o ka māmā; hoʻonui ʻia i loko o ke ākea parapharyngeal
Retropharyngeal Abscess Retropharyngeal Space (ma waena o ka paia hope o ka ʻāʻī/esophagus a me ka prevertebral fascia e uhi ana i ka iwi kuamoʻo) Na keiki (< 5 yrs): Suppuration of retropharyngeal lymph nodes after ear/nose/throat infection.
Nā makua: Komo i ka ** iwi iʻa a i ʻole iwi moa** ʻākala a i ʻole mea hana niho		 Ka ʻoʻoleʻa ʻāʻī nui, hōʻole i ka ʻāʻī a hoʻopaneʻe paha i ka ʻāʻī, torticollis (huli ʻia ke poʻo i kekahi ʻaoʻao), ke kuni kiʻekiʻe, drooling, leo puʻupuʻu, puʻupuʻu ka paia o ka pharyngeal hope. Ka hoʻouka ʻana o ka "Danger Space" (Space 4) e alakaʻi pololei ana i lalo i ka umauma hope (Descending Necrotizing Mediastinitis); kaomi ʻana o ke ea
Papharyngeal (Lateral Pharyngeal) Abscess ʻO kahi ākea-cone i hoʻohuli ʻia ma ka ʻaoʻao o ka pharynx, i loko o ka carotid sheath (ke aʻa carotid i loko, ʻaʻa iʻa kūloko, aʻalolo vagus) Laha ʻia mai kahi abscess peritonsillar, niho naʻauao haʻahaʻa, parotid gland, a i ʻole mastoiditis Trismus koʻikoʻi, ke kuni kiʻekiʻe, ʻōpuʻu ma waena o ka paia ʻāʻī ʻaoʻao holoʻokoʻa (e hoʻokuʻi ana i ka tonsil holoʻokoʻa i ka laina waena), pehu ʻuʻuku paʻa ma ka ** kihi o ka ʻāwae** Ka ʻaʻa ʻana o ke aʻaʻa Carotid a me ka hemorrhage puʻe pōʻino; ka thrombosis jugular vein i loko; maʻi lolo IX, X, XI, XII
Lemierre's Syndrome (Post-anginal Septicemia) Kaʻaʻa Carotid / ʻAʻa Kūloko Kuloko (septic thrombophlebitis) ʻO ka maʻi oropharyngeal hou i nā ʻōpio olakino a me nā ʻōpio makua i hoʻokumu ʻia e ka maʻi anaerobic Fusobacterium necrophorum ʻO ka ʻeha ʻāʻī i ʻike ʻia e hoʻomaikaʻi ʻia, hahai ʻia 4 a 12 mau lā ma hope mai e ** ke kuni kiʻekiʻe, nā haʻalulu ikaika , kahi pehu kaula ʻoluʻolu ma ka ʻiʻo sternocleidomastoid, a me ka ** ʻeha / ʻeha umauma pleuritic Septic pulmonary emboli (nā ʻōpū maʻi e haki ana i loko o ka māmā e hoʻoulu ai i ka maʻi pneumonia), empyema, a me ka fulminant. haʻalulu maʻemaʻe

Anatomy a me pathophysiology: No ke aha e lilo ai ka ʻeha niho a i ʻole ka tonsillitis i pilikia o ka umauma a me ke ea.

1. ʻO ke kānāwai "Mylohyoid Line": No ke aha e hoʻomaka ai nā molars haʻahaʻa i ka Ludwig's Angina

No ke aha e hoʻoulu pinepine ai ka ʻōpū i loko o ka niho mua a i ʻole ka mola luna i ka pehu papalina a i ʻole kahi ʻūhū liʻiliʻi, akā ʻo ka abscess i loko o ka molar lua haʻahaʻa a i ʻole mola kolu lalo (niho akamai) hiki ke hoʻopau i ke ala ea i loko o 24 mau hola? * Ua māhele ʻia ka papahele o ka waha e kahi diaphragm muscular i kapa ʻia ʻo ka mylohyoid muscle, e pili ana i kahi kuamoʻo diagonal ma loko o ka iwi ā lalo i kapa ʻia ʻo ka mylohyoid line. * Noho nā aʻa o ka ** niho mua, premolars, a me ka molar mua ** ma luna o ka laina mylohyoid. Ke hele lākou i ka abscess, hoʻopaʻa ʻia ka maʻi ma kahi pāpaʻu sublingual i loko o ka laina gum. * Eia naʻe, hiki i nā aʻa hohonu o ka molar lua haʻahaʻa a me ka molar kolu (niho akamai) hiki i ma lalo o ka laina mylohyoid pololei i loko o ka submandibular space o ka ʻāʻī. * I ka manawa o ka polymicrobial waha bacteria (he hui synergistic o Streptococcus viridans, Staphylococcus, a me na anaerobes waha pilau e like me Peptostreptococcus, Prevotella, a me Bacteroides) e puka i ka iwi lahilahi o ka ma'i ma lalo o ka mylohyoid line a puni ka laina anatomoid, e hooki ana i ka laina o ka mylohyoid. ʻo ka ʻaoʻao hope o ka ʻiʻo mylohyoid e hoʻoheheʻe ʻia ** nā wahi ʻekolu a pau o ka papahele o ka waha i ka manawa like ** (submandibular hema, submandibular ʻākau, a sublingual). * E hoʻomaopopo i kahi ʻoiaʻiʻo koʻikoʻi: ** ʻO ka angina o Ludwig he cellulitis gangrenous a me ka edema brawny e laha wikiwiki nei, ʻaʻole hoʻokahi ʻeke o ka pus. akā, huli ka ʻiʻo holoʻokoʻa o ka papahele waha a me ka ʻāʻī luna e like me ka paʻakikī e like me ka papa lāʻau.

2. The Cervical Fascial "Danger Space" (Space 4): ʻO ke ala nui mai ka ʻāʻī a i ka puʻuwai.

Ma hope o ka paia hope o ka ʻāʻī (ka pharynx hope a me ka esophagus) a ma ke alo o ka iwi kuamoʻo e moe ana ʻekolu mau mokulele fascial i hoʻopaʻa ʻia. 1. The Retropharyngeal Space: Hoʻonui ʻia mai ke kumu o ka iwi poʻo a hiki i ke kiʻekiʻe o ka umauma luna (ka vertebrae T1 a i ka T4, kokoke i ka bifurcation o ka puʻu makani), kahi e hui ai ka viscerovascular fascia. 2. Ka Alar Fascia: He pale lahilahi e hoʻokaʻawale ana i ka wahi retropharyngeal mai ka Danger Space ma hope o ia. 3. ** ʻO ka "Danger Space" (Alar-Prevertebral Space / Space 4):** ʻAʻole like me ka retropharyngeal space, ʻo ka Danger Space he paipu kūpaʻa mau ʻole o ka ʻiʻo areola wehe ʻole e holo pololei ana mai ke kumu o ka iwi poʻo i lalo i ka mediastinum hope o ka umauma a i ka diaphragm. * Ke hoʻopau ʻia ka retropharyngeal abscess, Ludwig's angina, a i ʻole ka maʻi parapharyngeal ma o ka alar fascia lahilahi i loko o ka Danger Space, kaumaha a me ka ʻumeke ʻino i hana ʻia i loko o ka umauma i kēlā me kēia manawa o ka mea maʻi e hanu maoli ai i ka pus a me ka necrotizing bacteria i lalo i loko o ka lua o ka umauma a puni ka puʻuwai, aorta, a me nā māmā. * ʻO kēia hoʻopiʻi pōʻino, i kapa ʻia ʻo Descending Necrotizing Mediastinitis (DNM), e lawe ana i ka 20 a i ka 40 pakeneka o ka make ʻana me ka hōʻoki ʻana i ka umauma hāmama. ʻO kona mau hōʻailona hōʻailona ʻo ** ka ʻeha o ka ʻūhā ma hope o ka iwi umauma (ʻeha hope)**, ** ʻulaʻula a me ka pehu pehu e kolo ana ma luna o nā ʻāʻī a me ka sternum luna **, a me ** subcutaneous crepitus ** (nā ʻūhū ʻea ma lalo o ka ʻili o ka ʻāʻī a me ka umauma i hana ʻia e nā kinoea hoʻohua anaerobic).

Pehea e hana ai i kahi hōʻoia hoʻāʻo palekana, non-invasive no nā maʻi ʻāʻī hohonu

ʻAʻole pono ʻoe e hoʻopaʻa i kahi puna, manamana lima, a i ʻole mea hana i loko o ka ʻāʻī o kekahi e hoʻoholo ai inā ua lilo ka ʻeha ʻeha a i ʻole ka maʻi niho i kahi ulia pōpilikia. Akā, e hana i kēia mau ʻelima palekana waho a me ka nānā ʻana i ka wā e noho pololei ana ka mea maʻi:

Nānā 1: ʻO ka ho'āʻo Trismus Manamana ʻElua / Manamana Manaʻo ʻEkolu

  • Ka wehe ʻana o ka ʻāwae maʻamau: Hiki i ke kanaka makua a i ʻole ke keiki olakino ke ʻākea ākea i ko lākou waha e kūpono i ** ʻekolu o ko lākou mau manamana lima ponoʻī i hoʻopaʻa pololei ʻia** ma waena o ko lākou mau niho incisor waena a me lalo (ma kahi o 35 a 50 millimeters / 1.4 a 2.0 iniha).
  • ** Trismus maikaʻi: ** E noi i ka mea maʻi e wehe mālie i ko lākou waha me ka ʻole e koi. Inā hiki iā lākou ke wehe wale i ko lākou ʻāwae ** hoʻokahi a ʻelua paha manamana lima ka laulā (ma lalo o 20 a 25 millimeters / 0.8 a 1.0 ʻīniha)** no ka ʻeha nui a me ka maʻi ʻiʻo i makemake ʻole ʻia, aia ʻo trismus.
  • He aha ka Trismus i hōʻoiaʻiʻo ai: ʻO ka pharyngitis viral maʻalahi a i ʻole ka puʻu paʻakikī ʻole ** ʻaʻole loa** ke kumu o ka trismus maoli. Hōʻike ʻo Trismus i ka hoʻonāukiuki ʻana o ka maʻi bacterial hohonu i ka medial pterygoid a i ʻole masseter muscle (nā ʻiʻo e pani ana i ka iwi ā), e hana ʻia ma peritonsillar abscess (quinsy), parapharyngeal abscess, a me Ludwig's angina.

Nānā 2: Nānā Kiʻekiʻe o ka papahele-o-waha a me ke alelo (Ludwig's Angina Check)

  • E nānā i ka waha o ka mea maʻi a ma lalo o ko lākou auwae mai waho.
  • Ka Hoʻomau "Woody" Submandibular: E ʻoluʻolu ma lalo o nā ʻaoʻao ʻelua o ka ʻauwae a me ka ʻauwae (me nā lima maʻemaʻe a i ʻole nā ​​lima lima lima lima). I ka ʻeha niho maʻamau a i ʻole ka pehu o ka lymph node, ʻoluʻolu a palupalu ka ʻiʻo ma lalo o ka ʻauwae me hoʻokahi puʻupuʻu palupalu o ka nui a i ʻole ke kinikini. I ka Ludwig's angina, ua pehu ka wahi holoʻokoʻa ma lalo o nā ʻaoʻao ʻelua o ka iwi ā i loko o ka "Bull Neck" a ua manaʻo ʻo ia ʻo rock-hard, tense, and board-like ("woody induration").
  • Ka hōʻailona "Double Tongue": E nānā i loko o ka waha me ka hoʻokomo ʻole i kekahi mea i loko. I ka Ludwig's angina, pehu ka ʻiʻo palupalu ma lalo o ke alelo (ka sublingual plica) a piʻi aʻe i ke kiʻekiʻe o nā niho haʻahaʻa, e like me ka lua o ka ʻulaʻula ma lalo o ke alelo, ʻoiai ʻo ke alelo ponoʻī e hoʻokuʻu ʻia i luna i ke kaupaku o ka waha a koi ʻia paha e puka i waho ma waena o nā niho.

Nānā 3: Uvula a me Soft Palate Asymmetry (Peritonsillar Abscess / Quinsy Check)

  • Inā hiki i ka mea maʻi ke hāmama iki i ko lākou waha me ka pilikia ʻole, e noi iā lākou e wehe mālie a nānā ʻoe i waho me ke kukui (mai hoʻohana i ka mea hoʻohaʻahaʻa alelo inā loaʻa iā ia ka stridor a i ʻole ka droo nui):
  • I loko o ka maʻi ʻaʻai paʻakikī, ʻulaʻula a pehu like nā tonsils ʻelua, a e kau pololei ana ka uvula (ke ʻiʻo liʻiliʻi me ke ʻano ʻeke punching e kau ana ma waenakonu o ke kua o ka ʻāʻī) e kau pololei ana i lalo i ka waena pololei.
  • I loko o kahi Peritonsillar Abscess (Quinsy), hōʻiliʻili ka pus ma luna a ma hope o hoʻokahi tonsil, e hoʻopololei ana i ka palale palupalu ma kēlā ʻaoʻao i lalo a i mua e like me ka pehu ʻulaʻula a ** e hoʻokuke ʻoi aku i ka ʻuvula ma kēlā ʻaoʻao o ka ʻāʻī**.

Nānā 4: Nānā i ka ʻāʻī o ka neʻe ʻana (Retropharyngeal Abscess Check)

  • Hiki i ka mea maʻi me ka ʻeha ʻeha maʻalahi ke kunou i ko lākou poʻo i luna a i lalo a huli i ko lākou poʻo hema a ʻākau.
  • I loko o ka retropharyngeal abscess, ua kū pololei ka ʻeke o ka pus i nā ʻiʻo prevertebral e uhi ana i ka iwi kuamoʻo. Hoʻopaʻa paʻa ka mea maʻi i ko lākou ʻāʻī me ka paʻa paʻa ʻia (hoʻi pinepine ʻia ma kekahi ʻaoʻao i ** torticollis i loaʻa ) a loaʻa i ka ʻeha ʻeha hohonu ke noi ʻia e hoʻonui i ko lākou ʻāʻī i hope (nānā i ke kaupaku) a i ʻole e hoʻopā i ko lākou ʻauwae i ko lākou umauma. I nā kamaliʻi liʻiliʻi, ** hōʻole i ka nānā ʻana i ke kaupaku i hui pū ʻia me ke kuni a me ka leo puʻupuʻu he hōʻailona maʻamau o kahi abscess retropharyngeal.

Nānā 5: Nānā leo a me ka Huā

  • E hoʻolohe i ke kani ʻana o "Hot Potato" leo (ma muli o ka edema o ka palale palupalu a i ʻole ka puʻu supraglottic e pale ana i ke kani ʻana o ka leo maʻamau) a nānā i ka drooling a i ʻole ke kuha mau ʻana o ke kohu i loko o ke kīʻaha a i ʻole ka ʻiʻo, e hōʻike ana i ke keakea mechanical a i ʻole ka odynophagia koʻikoʻi.

ʻO ke kōkua mua a me ka mālama prehospital no ka Deep Neck Infections

1. Hoʻonohonoho koke ʻia: ʻO ke kūlana kū pololei i mua

  • E hoʻonoho pololei i ka mea maʻi ma kahi ** 75-a-90-degere **, e hilinaʻi iki i mua me ko lākou mau kuʻe lima e kau ana ma luna o ka pākaukau, nā lima, a i ʻole ko lākou mau kuli.
  • No ke aha e ho'ōla ai i nā ola: Ke noho pololei a hilinaʻi iki i mua, huki ka umekaumaha i ke kumu alelo pehu ma mua (i mua), e hiki ai ke kulu mai ka waha i loko o ka waha ma mua o ke kahe ʻana i loko o ka larynx, a e hoʻemi i ke kaomi hydrostatic venous ma ke poʻo a me nā ʻāʻī ʻāʻī, e hoʻolohi i ka wikiwiki o ka pehu mucosal.
  • Ma ke kaʻa kaʻa a i ʻole ka hoʻāʻo ʻana i ka haukapila: Mai ʻae i nā limahana triage a i ʻole nā ​​​​mea lawe kaʻa e waiho i kahi mea maʻi me Ludwig's angina palahalaha ma luna o kahi kau no ka nānā ʻana i ke koko a i ʻole ka CT scan. Nui nā hopu ʻana i ke ea make ma Ludwig's angina a me retropharyngeal abscess i loko o ka lumi CT scan ke waiho ʻia ka mea maʻi e hanu pololei ana ma luna o ka papa scanner no 2 mau minuke.

ʻO ka poʻe ʻoi aku ka pilikia no ka piʻi wikiwiki ʻana o ka maʻi ʻāʻī hohonu

Hiki i nā poʻe me ka mālama maikaʻi ʻole ʻia ** ka maʻi maʻi diabetes**, HIV/AIDS, ** ka maʻi ʻāʻī a i ʻole ka maʻi ate**, chemotherapy a i ʻole corticosteroid immunosuppression, a i ʻole ** mau makahiki lōʻihi** hiki ke hoʻomohala i nā maʻi ʻāʻī hohonu e hoʻoweliweli i ke ola a me ka necrotizing mediastinitis me ke kuni mua a i ʻole ka ʻulaʻula. I nā poʻe maʻi maʻi maʻi maʻi maʻi, ʻo Klebsiella pneumoniae a me nā bacteria waha anaerobic hiki ke hoʻokaʻawale i nā mokulele fascial cervical ʻelua i ka wikiwiki e like me ka poʻe olakino i ka manawa like. ketoacidosis diabetic. ʻO kēlā me kēia maʻi maʻi diabetic a i ʻole immunocompromised me ka ʻāʻī hou, ʻāʻī ʻoʻoleʻa, leo puʻupuʻu, a i ʻole pilikia i ka ʻai ʻana i ka saliva e pono ke kiʻi koke i ka ʻoihana pilikia a me nā lāʻau antibiotic intravenous.

5. Prehospital Handoff Checklist no EMS a me Triage

Ke hōʻea mai nā lawelawe lapaʻau ulia pōpilikia a i ʻole ke hōʻike aku ʻoe i ke keʻena hoʻokolokolo hoʻokolokolo pilikia, e hōʻike koke i kēia mau ʻike ʻelima i hala ka mea maʻi i ka lumi kali nui: * [ ] Ka laina manawa hōʻailona pololei a me ke kumu o ka niho/puʻu: I ka wā i hoʻomaka ai ka ʻeha niho a ʻeha paha, a ʻo ka ʻaoʻao hea i pā mua ʻia. * [ ] ** Ke kūlana ea a me ke kū ʻana:** Inā lohe ka mea maʻi i ka stridor, drooling, ka leo "ʻuala wela", a i ʻole e noho pololei ma kahi kūlana tripod e hanu. * [ ] Ana Trismus: Ua kaupalena ʻia ka wehe ʻana o ka ʻāwae o ka mea maʻi ma lalo o ʻelua a ʻekolu mau manamana lima i hoʻopaʻa ʻia. * [ ] Ka palena o ka ʻili o ka waha a me ka ʻāʻī: Inā he lāʻau a paʻakikī paha ka ʻiʻo ma lalo o ka ʻauwae ma nā ʻaoʻao ʻelua, a inā paha ua hiki i ka ʻulaʻula a i ʻole crepitus (nā ʻōhū kinoea ma lalo o ka ʻili). * [ ] Wā NPO a me ka mōʻaukala lapaʻau: ʻO ka manawa pololei a ka mea maʻi i ʻai hope ai i kekahi wai a meaʻai paha, me kekahi moʻolelo o ka maʻi maʻi, nā mea hoʻokahe koko, a i ʻole ka maʻi maʻi penicillin.

2. Hoʻomalu i ka ʻeha, ka ʻeha, a me ka hoʻomaʻemaʻe ʻana me ka palekana

  • E hāʻawi i ke kīʻaha kuha a i ʻole ke kāwele: Hāʻawi i ka mea maʻi i kīʻaha, kīʻaha, a i ʻole ʻāʻī o nā ʻiʻo a kauoha iā ia e hoʻokuʻu i ka ʻili ma mua o ko lākou waha ma mua o ka hoʻāʻo ʻana e moni ikaika.
  • Ke kūlana NPO koʻikoʻi: Mai hāʻawi i ka meaʻai, ka wai, a i ʻole nā ​​​​palapala waha. ʻAʻole ʻo ka ʻai wale ʻana i ka pilikia a me ka hoʻomake ʻana, akā ʻo ka peritonsillar abscess, retropharyngeal abscess, a i ʻole Ludwig's angina e koi koke i ka ʻoki ʻoki a me ka hoʻokahe wai (I&D) a i ʻole ka fiberoptic intubation, kahi e pale ai ka ʻōpū ʻole i ka maʻi maʻi maʻi aspiration.
  • Nā hoʻoluʻu o waho (no ka hōʻoluʻolu wale nō): ʻOiai e kali ana i ka lawe ʻana i ka mea maʻi me ka ʻōpū peritonsillar a i ʻole ka pehu niho ʻaʻole * he stridor, ʻo ka paʻa ʻana i kahi lole i ʻōwili ʻia a puni ka ʻeke maloʻo ma ka waho o ka pāpālina a i ʻole ka ʻāʻī (ʻaʻole e kaomi paʻa i ka ʻāʻī a i ʻole ka makani) hiki ke hoʻopaʻa i ka ʻeha o ke aʻalolo me ka hoʻonui ʻole o ke koko. Mai hoʻopili i nā pā mehana wela a i ʻole nā ​​hue wai wela ma waho o ka ʻāʻī pehu a i ʻole ka ʻāʻī, no ka mea, hoʻomāhuahua ka wela i nā kīʻaha koko, hoʻolalelale i ka edema bacteria, a hiki ke huki i ka ʻōpū niho i waho ma ka ʻili o ka maka (e hana ana i kahi fistula odontogenic cutaneous mau loa).

3. ʻŌlelo Aʻo Kūikawā: NSAID a me nā maʻi niho i mālama ʻole ʻia

  • Ua ʻike ʻia nā haʻawina hoʻonaʻauao a me nā ʻōlelo aʻo olakino olakino (e like me ka ʻoihana lapaʻau ʻāina ʻo Farani ANSM a me nā kino ʻoki waha o ʻEulopa) i ka lawe ʻana i nā kiʻekiʻe o ** nā lāʻau anti-inflammatory non-steroidal (NSAIDs e like me ibuprofen, ketorolac, a i ʻole naproxen) me ka ʻole o nā lāʻau ʻokoʻa like ʻole* i ka wā o ka maʻi maʻi bacterial mua a i ʻole tonsillar a me ka maʻi neʻe keʻokeʻo hiki ke hoʻomaʻamaʻa. chemotaxis, hiki ke ʻae i kahi maʻi niho kūloko a i ʻole pharyngitis e holomua mālie i loko o ka cervicofacial cellulitis koʻikoʻi, Ludwig's angina, a i ʻole necrotizing fasciitis. ʻO kēlā me kēia ʻeha niho i hui pū ʻia me ka pehu ʻana o ka maka, ka ʻāwae, a i ʻole ka submandibular e pono ai ka loiloi ʻoihana niho / lāʻau lapaʻau a me ka hoʻokele kumu kumu (drainage a me nā antibiotic), ʻaʻole ka lāʻau ponoʻī me nā lāʻau ʻeha wale nō.

4. E hoʻomākaukau ana no ka hoʻokele ʻana i ke ala ea

  • Ke kāhea ʻoe iā 911/112/999 a i ʻole e hōʻea i ke keʻena pilikia, e hāʻawi i ke kahu triage a i ʻole ka paramedic i kahi hōʻuluʻulu akaka:
    • "Ua loaʻa i kēia mea maʻi ka ʻeha niho molar haʻahaʻa / ʻeha ʻāʻī no nā lā X a i kēia manawa he pehu lāʻau bilateral ma lalo o ka auwae, trismus (hiki ʻole ke wehe i ko lākou waha), drooling, a me kahi alelo kiʻekiʻe. Ua hopohopo mākou no ka Ludwig's angina / deep neck abscess."*
  • I loko o ka haukapila, hāʻawi koke ʻia nā mea maʻi me ka Ludwig's angina i loko o ka intravenous dexamethasone (e hōʻemi i ka edema o ke ea), broad-spectrum ** intravenous antibiotics** (e uhi ana i ka streptococci, staphylococci, a me nā anaerobes waha), a loiloi ʻia e ka ear-nose-and-throat (ENT) surgeologist for anessal fiberoptic* a i ʻole he tracheostomy local-anesthetic ** ala ma mua o ka hoʻohaʻahaʻa ʻana i ka ʻāʻī.

ʻO ka ʻike ʻana i ka wā i hele ai ka ʻeha niho a i ʻole ka ʻeha ʻeha i ka laina i loko o kahi maʻi ʻāʻī hohonu e pale ai i ka pōʻino ea. E noʻonoʻo e lawe i kahi papa kōkua mua i hōʻoia ʻia ma o kāu hui Red Cross a i ʻole Red Crescent, St John Ambulance, a i ʻole ka American Heart Association.

Nīnau pinepine

How can an ordinary lower wisdom toothache turn into a life-threatening airway emergency like Ludwig's angina?

The roots of your lower second and third molars (wisdom teeth) extend deep inside the lower jawbone below a muscular boundary called the mylohyoid line. When an untreated cavity or gum infection in one of those back lower molars forms an abscess that breaks through the thin inner wall of the jawbone, the bacteria spill directly into the submandibular space beneath the floor of your mouth. Within 12 to 48 hours, the infection spreads across both sides of the jaw under the chin, turning the tissue beneath the chin rock-hard like a wooden board. Because the jawbone prevents the swelling from expanding outward, the swelling pushes the floor of the mouth and the tongue straight upward and backward against the roof of the mouth and throat, cutting off breathing. Any toothache that causes swelling under both sides of the chin, difficulty swallowing saliva, or an elevated tongue requires an immediate emergency department visit.

How do I tell the difference between regular tonsillitis and a peritonsillar abscess (quinsy)?

In regular viral or strep tonsillitis, both sides of your throat hurt roughly equally, both tonsils look swollen on the left and right, the uvula hangs straight down in the middle of your throat, and you can still open your mouth wide. A peritonsillar abscess (quinsy) happens when pus forms a pressurized pocket behind one tonsil. It causes four unmistakable signs: first, the throat pain becomes severely one-sided and radiates sharply into your ear on that same side; second, you develop trismus (lockjaw), meaning painful muscle spasms prevent you from opening your mouth more than one or two fingers wide; third, your voice sounds muffled like you are holding a hot potato in your mouth; and fourth, looking in the mirror reveals a big swollen bulge above one tonsil that shoves your uvula sideways toward the opposite tonsil. Quinsy cannot be cured by pills alone; an emergency doctor or ENT specialist must drain the pocket of pus and give antibiotics.

Why must a patient with Ludwig's angina or a deep throat abscess never lie flat on their back, even for a hospital CT scan?

In Ludwig's angina or a large deep neck abscess, the base of the tongue and the soft tissues of the throat are massively swollen and heavy with fluid. As long as the patient sits bolt upright and leans slightly forward, gravity pulls the heavy tongue forward and lets saliva drip out of the mouth, keeping a narrow passage open behind the tongue for air to reach the windpipe. The moment the patient lies flat on their back, gravity drops the swollen tongue base straight backward against the back wall of the throat, completely sealing off the airway. Worse still, because jaw spasm (trismus) locks the teeth together and swelling fills the mouth, doctors cannot easily pass a breathing tube through the mouth once the patient lies flat and stops breathing. Always keep the patient sitting upright during transport and triage.

What is Lemierre's syndrome, and when should a young adult with a sore throat worry about it?

Lemierre's syndrome is a rare but dangerous complication of a bacterial sore throat, most often striking healthy teenagers and young adults between 15 and 30 years old. It is usually caused by an anaerobic bacterium called Fusobacterium necrophorum. Typically, the person has a bad sore throat for a few days that may even start to feel slightly better, but then 4 to 10 days later they suddenly develop spiking high fevers, violent shaking chills (rigors), tenderness and swelling along one side of the neck (where the infection has caused a septic blood clot inside the internal jugular vein), and new cough or sharp chest pain as tiny infected clots travel to the lungs. Anyone who develops high fevers, shaking chills, one-sided neck tenderness, or shortness of breath several days after a sore throat needs immediate hospital evaluation for intravenous antibiotics.

Nānā ʻia nā kumu

  • American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS, United States): Ke alakaʻi lapaʻau no nā maʻi maʻi ʻāʻī hohonu, Peritonsillar Abscess, a me Ludwig's Angina Airway Management.
  • National Institute for Health and Care Excellence (NICE, United Kingdom) & ENT UK: Acute Sore Throat, Peritonsillar Abscess (Quinsy), a me Deep Neck Space Infection Triage Guidelines.
  • Ahahui niho ʻAmelika (ADA) & ʻAhahui ʻAmelika o nā Kauka Oral and Maxillofacial Surgeons (AAOMS, ʻAmelika Hui Pū ʻIa): Management of Odontogenic Deep Fascial Space Infections and Trismus Assessment.
  • Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM, Palani): Palapala Palekana ma ka hoʻohana ʻana i ka NSAID i nā maʻi maʻi odontogenic a me nā maʻi maʻi pharyngeal.
  • World Society of Emergency Surgery (WSES, International): Diagnosis and Management of Severe Soft Tissue and Necrotizing Cervicofacial Infections / Descending Necrotizing Mediastinitis.

Nā alakaʻi pili