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...

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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
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description 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.
doi_str_mv 10.1136/bcr-2018-224634
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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. 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source PMC (PubMed Central)
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
title A severe deep neck odontogenic infection not prioritised by the emergency department triage system and National Early Warning Score
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