A severe deep neck odontogenic infection not prioritised by the emergency department triage system and National Early Warning Score

A 62-year-old man with a background of type 2 diabetes mellitus presented to the emergency department (ED) with a 5-day history of dental pain, progressive right facial swelling, trismus, dysphagia and voice changes. The oropharynx could not be directly examined completely due to trismus. The patien...

Full description

Saved in:
Bibliographic Details
Published in:BMJ case reports 2018-05, Vol.2018, p.bcr-2018-224634
Main Authors: Wates, Emma, Higginson, James, Kichenaradjou, Andre, McVeigh, Kieron
Format: Article
Language:English
Subjects:
Airway management
Algorithms
Case reports
Clinical deterioration
Deglutition Disorders - diagnosis
Deglutition Disorders - etiology
Design
Diagnosis, Differential
Ears & hearing
Emergency Service, Hospital - standards
Family medical history
Hospitals
Humans
Infections
Intensive care
Intubation
Learning from Errors
Male
Medical imaging
Medical prognosis
Middle Aged
Mortality
Neck - diagnostic imaging
Neck - microbiology
Neck - pathology
Neck - surgery
Oropharynx - diagnostic imaging
Oropharynx - microbiology
Oropharynx - pathology
Oropharynx - surgery
Pain - diagnosis
Pain - etiology
Patient assessment
Patients
Periapical Abscess - diagnostic imaging
Periapical Abscess - drug therapy
Periapical Abscess - microbiology
Periapical Abscess - surgery
Primary care
Respiration
Respiratory Insufficiency - complications
Respiratory Insufficiency - rehabilitation
Tomography, X-Ray Computed - methods
Treatment Outcome
Triage - standards
Trismus - diagnosis
Trismus - etiology
Vital signs
Voice Disorders - diagnosis
Voice Disorders - etiology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A 62-year-old man with a background of type 2 diabetes mellitus presented to the emergency department (ED) with a 5-day history of dental pain, progressive right facial swelling, trismus, dysphagia and voice changes. The oropharynx could not be directly examined completely due to trismus. The patient had a National Early Warning Score of 0 and so was triaged into the ‘minors’ section of ED. Following assessment by the on-call oral and maxillofacial surgeon, an urgent contrast-enhanced CT demonstrated a large parapharyngeal collection, which required urgent anaesthetic and surgical intervention. The patient developed pulmonary complications postoperatively, but eventually made a full recovery.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2018-224634