The heat is on ⋯ thermal epiglottitis as a late presentation of airway steam injury

Sapna R Kudchadkar, Justin T. Hamrick, Christine L. Mai, Ivor David Berkowitz, David E Tunkel

Research output: Contribution to journalArticle

Abstract

Background Thermal epiglottitis is a rare but potentially life-threatening disease. Diagnosis requires a thorough history and high clinical level of suspicion, particularly in children. Thermal epiglottitis from steam inhalation can have a slow onset without oropharyngeal signs of thermal injury, findings that can hide the clinical diagnosis. Objective Our aim was to review the pathophysiology and clinical presentation of thermal epiglottitis and the challenges involved in diagnosis and management of this form of atypical epiglottitis. Case Report We describe the case of a 22-month-old male presenting to the pediatric emergency department after a scald burn from steam and boiling water resulting in 12% body surface area burns to his chin, chest, and shoulder, with no obvious oropharyngeal or neck injuries. At the time of presentation, he was afebrile and well appearing. Six hours after the injury, he was sitting in the "tripod position," drooling, with pooled saliva in his mouth and inspiratory stridor. Intubation in the operating room using conventional direct laryngoscopy was not successful and he was intubated using an operative endoscope. Laryngoscopy demonstrated thermal epiglottitis. A tracheostomy was performed to secure the airway, and he was admitted to the pediatric intensive care unit. He was discharged home and decannulated 4 weeks later, when airway endoscopy showed complete recovery with normal airway structures. Conclusion A thorough history and physical examination together with a high level of suspicion and aggressive, collaborative airway management is vital in preventing catastrophic airway obstruction in atypical forms of epiglottitis.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
Volume46
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Epiglottitis
Steam
Hot Temperature
Wounds and Injuries
Laryngoscopy
History
Sialorrhea
Neck Injuries
Chin
Pediatric Intensive Care Units
Airway Management
Endoscopes
Tracheostomy
Body Surface Area
Respiratory Sounds
Airway Obstruction
Operating Rooms
Burns
Saliva
Intubation

Keywords

  • airway obstruction
  • burns
  • emergency
  • intubation
  • pediatrics
  • transport medicine

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The heat is on ⋯ thermal epiglottitis as a late presentation of airway steam injury. / Kudchadkar, Sapna R; Hamrick, Justin T.; Mai, Christine L.; Berkowitz, Ivor David; Tunkel, David E.

In: Journal of Emergency Medicine, Vol. 46, No. 2, 02.2014.

Research output: Contribution to journalArticle

@article{4777a25c8f2842e09aa474b96cee777f,
title = "The heat is on ⋯ thermal epiglottitis as a late presentation of airway steam injury",
abstract = "Background Thermal epiglottitis is a rare but potentially life-threatening disease. Diagnosis requires a thorough history and high clinical level of suspicion, particularly in children. Thermal epiglottitis from steam inhalation can have a slow onset without oropharyngeal signs of thermal injury, findings that can hide the clinical diagnosis. Objective Our aim was to review the pathophysiology and clinical presentation of thermal epiglottitis and the challenges involved in diagnosis and management of this form of atypical epiglottitis. Case Report We describe the case of a 22-month-old male presenting to the pediatric emergency department after a scald burn from steam and boiling water resulting in 12{\%} body surface area burns to his chin, chest, and shoulder, with no obvious oropharyngeal or neck injuries. At the time of presentation, he was afebrile and well appearing. Six hours after the injury, he was sitting in the {"}tripod position,{"} drooling, with pooled saliva in his mouth and inspiratory stridor. Intubation in the operating room using conventional direct laryngoscopy was not successful and he was intubated using an operative endoscope. Laryngoscopy demonstrated thermal epiglottitis. A tracheostomy was performed to secure the airway, and he was admitted to the pediatric intensive care unit. He was discharged home and decannulated 4 weeks later, when airway endoscopy showed complete recovery with normal airway structures. Conclusion A thorough history and physical examination together with a high level of suspicion and aggressive, collaborative airway management is vital in preventing catastrophic airway obstruction in atypical forms of epiglottitis.",
keywords = "airway obstruction, burns, emergency, intubation, pediatrics, transport medicine",
author = "Kudchadkar, {Sapna R} and Hamrick, {Justin T.} and Mai, {Christine L.} and Berkowitz, {Ivor David} and Tunkel, {David E}",
year = "2014",
month = "2",
doi = "10.1016/j.jemermed.2013.08.033",
language = "English (US)",
volume = "46",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - The heat is on ⋯ thermal epiglottitis as a late presentation of airway steam injury

AU - Kudchadkar, Sapna R

AU - Hamrick, Justin T.

AU - Mai, Christine L.

AU - Berkowitz, Ivor David

AU - Tunkel, David E

PY - 2014/2

Y1 - 2014/2

N2 - Background Thermal epiglottitis is a rare but potentially life-threatening disease. Diagnosis requires a thorough history and high clinical level of suspicion, particularly in children. Thermal epiglottitis from steam inhalation can have a slow onset without oropharyngeal signs of thermal injury, findings that can hide the clinical diagnosis. Objective Our aim was to review the pathophysiology and clinical presentation of thermal epiglottitis and the challenges involved in diagnosis and management of this form of atypical epiglottitis. Case Report We describe the case of a 22-month-old male presenting to the pediatric emergency department after a scald burn from steam and boiling water resulting in 12% body surface area burns to his chin, chest, and shoulder, with no obvious oropharyngeal or neck injuries. At the time of presentation, he was afebrile and well appearing. Six hours after the injury, he was sitting in the "tripod position," drooling, with pooled saliva in his mouth and inspiratory stridor. Intubation in the operating room using conventional direct laryngoscopy was not successful and he was intubated using an operative endoscope. Laryngoscopy demonstrated thermal epiglottitis. A tracheostomy was performed to secure the airway, and he was admitted to the pediatric intensive care unit. He was discharged home and decannulated 4 weeks later, when airway endoscopy showed complete recovery with normal airway structures. Conclusion A thorough history and physical examination together with a high level of suspicion and aggressive, collaborative airway management is vital in preventing catastrophic airway obstruction in atypical forms of epiglottitis.

AB - Background Thermal epiglottitis is a rare but potentially life-threatening disease. Diagnosis requires a thorough history and high clinical level of suspicion, particularly in children. Thermal epiglottitis from steam inhalation can have a slow onset without oropharyngeal signs of thermal injury, findings that can hide the clinical diagnosis. Objective Our aim was to review the pathophysiology and clinical presentation of thermal epiglottitis and the challenges involved in diagnosis and management of this form of atypical epiglottitis. Case Report We describe the case of a 22-month-old male presenting to the pediatric emergency department after a scald burn from steam and boiling water resulting in 12% body surface area burns to his chin, chest, and shoulder, with no obvious oropharyngeal or neck injuries. At the time of presentation, he was afebrile and well appearing. Six hours after the injury, he was sitting in the "tripod position," drooling, with pooled saliva in his mouth and inspiratory stridor. Intubation in the operating room using conventional direct laryngoscopy was not successful and he was intubated using an operative endoscope. Laryngoscopy demonstrated thermal epiglottitis. A tracheostomy was performed to secure the airway, and he was admitted to the pediatric intensive care unit. He was discharged home and decannulated 4 weeks later, when airway endoscopy showed complete recovery with normal airway structures. Conclusion A thorough history and physical examination together with a high level of suspicion and aggressive, collaborative airway management is vital in preventing catastrophic airway obstruction in atypical forms of epiglottitis.

KW - airway obstruction

KW - burns

KW - emergency

KW - intubation

KW - pediatrics

KW - transport medicine

UR - http://www.scopus.com/inward/record.url?scp=84892968681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892968681&partnerID=8YFLogxK

U2 - 10.1016/j.jemermed.2013.08.033

DO - 10.1016/j.jemermed.2013.08.033

M3 - Article

C2 - 24113478

AN - SCOPUS:84892968681

VL - 46

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

IS - 2

ER -