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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

SYMPTOMS/EXAM

■ Respiratory distress

■ Barking seal–like cough

■ Severe cases may have stridor.

■ Hoarseness

■ URI signs and symptoms

■ Low-grade fever may be present.

DIAGNOSIS

■ Clinical exam

■ X-ray (usually not necessary) may show “steeple sign”on AP view (nar-

rowing of larynx 5–10 mm below vocal cords) (see Figure 14.18).

TREATMENT

■ Steroids are indicated. Dexamethasone 0.6 mg/kg IM is a standard dose,

inhaled, or oral steroids also work.

■ Nebulized epinephrine

■ No antibiotics needed

■ Self-limiting, rarely fatal

■ Consider admission if: Significant respiratory distress, persistent signs and

symptoms despite ED treatment, dehydration or unable to tolerate PO,

multiple doses of racemic epinephrine, or social issues.

Ludwig Angina

ETIOLOGY

■ Deep space neck infection involving the submandibular, submental, and

sublingual spaces (see Figure 14.9).

■ Often odontogenic in origin (molars most commonly) and immunocom-

promised (diabetics)

■ Mixed aerobic and anaerobic etiology

FIGURE 14.18. Subglottic narrowing, referred to as the steeple sign, in patient with croup.

(Reproduced, with permission, from Stone CK, Humphries, RL. Current Emergency Diagnosis

and Treatment, 5th ed. New York: McGraw-Hill, 2004:648.)