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The heat is on... thermal epiglottitis as a late presentation of airway steam injury.
J Emerg Med. 2014 Feb; 46(2):e43-6.JE

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.

Authors+Show Affiliations

Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.Division of Pediatric Otolaryngology, Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

24113478

Citation

Kudchadkar, Sapna R., et al. "The Heat Is On... Thermal Epiglottitis as a Late Presentation of Airway Steam Injury." The Journal of Emergency Medicine, vol. 46, no. 2, 2014, pp. e43-6.
Kudchadkar SR, Hamrick JT, Mai CL, et al. The heat is on... thermal epiglottitis as a late presentation of airway steam injury. J Emerg Med. 2014;46(2):e43-6.
Kudchadkar, S. R., Hamrick, J. T., Mai, C. L., Berkowitz, I., & Tunkel, D. (2014). The heat is on... thermal epiglottitis as a late presentation of airway steam injury. The Journal of Emergency Medicine, 46(2), e43-6. https://doi.org/10.1016/j.jemermed.2013.08.033
Kudchadkar SR, et al. The Heat Is On... Thermal Epiglottitis as a Late Presentation of Airway Steam Injury. J Emerg Med. 2014;46(2):e43-6. PubMed PMID: 24113478.
* Article titles in AMA citation format should be in sentence-case
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, AU - Tunkel,David, Y1 - 2013/10/07/ PY - 2013/01/16/received PY - 2013/08/14/accepted PY - 2013/10/12/entrez PY - 2013/10/12/pubmed PY - 2014/9/30/medline KW - airway obstruction KW - burns KW - emergency KW - intubation KW - pediatrics KW - transport medicine SP - e43 EP - 6 JF - The Journal of emergency medicine JO - J Emerg Med VL - 46 IS - 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. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/24113478/The_heat_is_on____thermal_epiglottitis_as_a_late_presentation_of_airway_steam_injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(13)00943-8 DB - PRIME DP - Unbound Medicine ER -