Traumatic Epiglottitis following a Blind Insertion of the ...
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Case Report Traumatic Epiglottitis following a Blind Insertion of the Hand during Convulsion Koji Yokoyama Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan Correspondence should be addressed to Koji Yokoyama; [email protected] Received 19 June 2018; Accepted 18 July 2018; Published 28 August 2018 Academic Editor: Nina L. Shapiro Copyright © 2018 Koji Yokoyama. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Traditionally, it has been recommended that first-responders should place chopsticks or their hand in a child’s mouth to prevent the child from biting their tongue during convulsion. e practice persists locally in parts of Japan and can cause adverse events. We report a traumatic epiglottitis following the thrusting of a guardians’ hand into a 13-month-old girl’s mouth to prevent her from biting her tongue. 1. Case Presentation Inappropriate maneuvers persist in cardiopulmonary re- suscitation. For example, the prevention of and relief from “tongue swallowing” appears to take priority over chest compression [1]. In Japan, it is recommended traditionally that the first-responder should place chopsticks or their hand in a child’s mouth to prevent biting of the tongue during convulsions. is practice is used locally in parts of Japan, and can cause adverse events. Here, we report a case of traumatic epiglottitis following the thrusting of a guard- ian’s hand into the mouth of a small girl to prevent her from biting her tongue. A 13-month-old female was admitted to our emergency department because of sursumvergence and disturbance of consciousness. She received hypothermia therapy following an incidence of neonatal asphyxia during the newborn period. She did not have a history of convulsive seizures. She was appropriately vaccinated for her age, including against Haemophilus influenza type B. e child’s grandmother found her unconscious and attempted to prevent the child from biting her tongue by forcefully opening her mouth and placing her fingers in the child’s mouth. At presentation at the emergency room, the patient was conscious and alert, afebrile, and showed vesicular breath sounds and no rale. Her temperature was 36.9 ° C, respiratory rate was 45 breaths/min, pulse rate was 142beats/min, and blood pressure was 130/80 mmHg. After a few hours, the patient developed ir- ritability, drooling, inspiratory stridor, and sternal retraction. Enhanced computed tomography showed no foreign bodies in the airway or esophagus. She appeared ill, irritable, and in moderate respiratory distress, which did not improve with racemic epinephrine and systemic corticosteroid therapy. e otolaryngologist service performed a laryngoscopic exami- nation, which revealed left side erythema and an edematous epiglottis and aryepiglottic folds consistent with acute epi- glottitis (Figure 1). e patient was admitted to the intensive care unit. An intubation tube was placed without difficulty, and she was treated with intravenous antibiotics and corti- costeroid therapy. On day four after intubation, the patient’s epiglottis appeared normal by laryngoscopic examination, and she was subsequently extubated. Following overnight observation, the child was discharged to home at 6 days after her emergency intubation. Cultures of the epiglottis and blood were negative. 2. Discussion Despite a reduced incidence of infectious epiglottitis following the introduction of the Haemophilus influenza type B con- jugate vaccine, physicians must pay attention to this life-threatening cause of airway obstruction [2–4]. Previously, Hindawi Case Reports in Pediatrics Volume 2018, Article ID 8398502, 2 pages https://doi.org/10.1155/2018/8398502
Transcript of Traumatic Epiglottitis following a Blind Insertion of the ...
Case ReportTraumatic Epiglottitis following a Blind Insertion of theHand during Convulsion
Koji Yokoyama
Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
Correspondence should be addressed to Koji Yokoyama; [email protected]
Received 19 June 2018; Accepted 18 July 2018; Published 28 August 2018
Academic Editor: Nina L. Shapiro
Copyright © 2018 Koji Yokoyama. +is is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Traditionally, it has been recommended that first-responders should place chopsticks or their hand in a child’s mouth to preventthe child from biting their tongue during convulsion. +e practice persists locally in parts of Japan and can cause adverse events.We report a traumatic epiglottitis following the thrusting of a guardians’ hand into a 13-month-old girl’s mouth to prevent herfrom biting her tongue.
1. Case Presentation
Inappropriate maneuvers persist in cardiopulmonary re-suscitation. For example, the prevention of and relief from“tongue swallowing” appears to take priority over chestcompression [1]. In Japan, it is recommended traditionallythat the first-responder should place chopsticks or theirhand in a child’s mouth to prevent biting of the tongueduring convulsions. +is practice is used locally in parts ofJapan, and can cause adverse events. Here, we report a caseof traumatic epiglottitis following the thrusting of a guard-ian’s hand into the mouth of a small girl to prevent her frombiting her tongue.
A 13-month-old female was admitted to our emergencydepartment because of sursumvergence and disturbance ofconsciousness. She received hypothermia therapy followingan incidence of neonatal asphyxia during the newbornperiod. She did not have a history of convulsive seizures. Shewas appropriately vaccinated for her age, including againstHaemophilus influenza type B. +e child’s grandmotherfound her unconscious and attempted to prevent the childfrom biting her tongue by forcefully opening her mouth andplacing her fingers in the child’s mouth. At presentation atthe emergency room, the patient was conscious and alert,afebrile, and showed vesicular breath sounds and no rale. Hertemperature was 36.9°C, respiratory rate was 45 breaths/min,
pulse rate was 142 beats/min, and blood pressure was130/80mmHg. After a few hours, the patient developed ir-ritability, drooling, inspiratory stridor, and sternal retraction.Enhanced computed tomography showed no foreign bodiesin the airway or esophagus. She appeared ill, irritable, and inmoderate respiratory distress, which did not improve withracemic epinephrine and systemic corticosteroid therapy.+eotolaryngologist service performed a laryngoscopic exami-nation, which revealed left side erythema and an edematousepiglottis and aryepiglottic folds consistent with acute epi-glottitis (Figure 1). +e patient was admitted to the intensivecare unit. An intubation tube was placed without difficulty,and she was treated with intravenous antibiotics and corti-costeroid therapy. On day four after intubation, the patient’sepiglottis appeared normal by laryngoscopic examination,and she was subsequently extubated. Following overnightobservation, the child was discharged to home at 6 days afterher emergency intubation. Cultures of the epiglottis andblood were negative.
2. Discussion
Despite a reduced incidence of infectious epiglottitis followingthe introduction of the Haemophilus influenza type B con-jugate vaccine, physicians must pay attention to thislife-threatening cause of airway obstruction [2–4]. Previously,
HindawiCase Reports in PediatricsVolume 2018, Article ID 8398502, 2 pageshttps://doi.org/10.1155/2018/8398502
there were reports of traumatic epiglottitis following forcefulinsertion of a guardian’s hand into the mouth to removeforeign bodies including fatal outcomes [5–8]. Our case il-lustrates physicians should be aware of the possibility ofinappropriate cardiopulmonary resuscitation manipulationrelated acute epiglottis. In addition, there is urgent need toensure the use of appropriate cardiopulmonary resuscitationmaneuvers, especially in young children.
Conflicts of Interest
+e author has no conflicts of interest to declare.
Authors’ Contributions
KY designed the study, collected and analyzed data, andwrote the manuscript.
References
[1] D. Viskin, R. Rosso, O. Havakuk, L. Yankelson, and S. Viskin,“Attempts to prevent “tongue swallowing” may well be themain obstacle for successful bystander resuscitation of athleteswith cardiac arrest,” Heart Rhythm, vol. 14, no. 11, pp. 1729–1734, 2017.
[2] H. Faden, “+e dramatic change in the epidemiology of pe-diatric epiglottitis,” Pediatric Emergency Care, vol. 22, no. 6,pp. 443-444, 2006.
[3] M. N. Hermansen, J. H. Schmidt, A. H. Krug, K. Larsen, andS. Kristensen, “Low incidence of children with acute epiglottisafter introduction of vaccination,” Danish Medical Journal,vol. 61, no. 4, article A4788, 2014.
[4] J. McVernon, M. P. Slack, and M. E. Ramsay, “Changes in theepidemiology of epiglottitis following introduction of Hae-mophilus influenzae type b (Hib) conjugate vaccines in En-gland: a comparison of two data sources,” Epidemiology andInfection, vol. 134, no. 3, pp. 570–572, 2006.
[5] H. A. Abder-Rahman, “Infants choking following blind fingersweep,” Jornal de Pediatria, vol. 85, no. 3, pp. 273–275, 2009.
[6] M. Kabbani and S. R. Goodwin, “Traumatic epiglottis followingblind finger sweep to remove a pharyngeal foreign body,”Clinical Pediatrics, vol. 34, no. 9, pp. 495–497, 1995.
[7] K. R. Kavanagh and J. S. Batti, “Traumatic epiglottitis afterforeign body ingestion,” International Journal of PediatricOtorhinolaryngology, vol. 72, no. 6, pp. 901–903, 2008.
[8] K. Yen, V. Flanary, C. Estel, N. Farber, and H. Hennes,“Traumatic epiglottitis,” Pediatric Emergency Care, vol. 19,no. 1, pp. 27-28, 2003.
Figure 1: Image from the laryngoscopic examination showing theleft side erythema and edematous epiglottis and aryepiglottic folds.
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