Not just a Toothache

[brock8024]

Ok I had a eye opener of a call a few weeks ago. It was one that could have went really bad very fast. Here is the over view of what happened.

40 year old african american female with complaints of chest pain. When me and my partner got there she was sitting on the side of her bed and would not answer our questions. Her husband was very nice and would give us the best hx he could. Our pt would shake her head yes and no and everyone once in a while speak very soft. The chest pain was always a 6 or 7 out of 10. The pain radiated to her back, under her clavicles and up her jaw. Her only hx was abscess tooth 3 days prior and was on treatment for that. We get her to the truck and notice that her neck looks like she has a goiter. It was kind of swollen looking but our pt is 5'5 or so and is about 250 or so. She is hypertensive and her spo2 is low around 91 or so. Place her on some oxygen, notice she is sinus tach about 120's. When she does try to talk we noticed that she drooled a little. Was unable to get a IV, which was no surprise she told us they normally have to place a triple luman. We was just about 3 mins from ER. Got her there they knew her. The ER doctor also noticed her neck. Pt was worked up for Chest pain for sure and was then rushed to the OR to be intubated.

Why was this pt intubated? Well she had a very life threating condition. It was caused due to her abscess tooth. The pt's airway was about 50% blocked off and very easily been all the way and needed to be trached in the field.

Well I have told you the story now lets see if someone can come up with what was wrong with this pt. It is a good learning case. I put it under pt care because there are many times that we think oh a toothache but it can turn into a deadly thing for your pt.

So I know what was wrong and I know dust does too. So someone post what was wrong with my pt.

[theotherphil]

Sepsis?

[brock8024]

Sepsis?

Sorry but that is not right. Please explain why sepsis would cause her airway to be obstructed.

[mobey]

Epiglottitis?

[ERDoc]

Could be wrong, but it sounds like angina to me. :wink:

[JPINFV]

Lymphocytes reproducing in the lymph nodes in the neck that drain the interstitial fluid from the mouth could be an extreme possibility.

[brock8024]

One of you are really close but there is a name for it. Not saying who is close though. LOL

[rat115]

I have to admit that I googled this. I have had trouble with my teeth in the past and had to have a root canal at 16, so this post really got me to thinking.

It turns out that I found the name is Ludwig's Angina. The pus generated by the infection forms pockets which grow and cause cellulitis in the face and neck. These pocket of pus cause the airway to close off and sufficate the person. Hence, the life threatening emergency.

Now, the next question for others.....How can this type of infection develope to the point that it's life threatening?

[brock8024]

I have to admit that I googled this. I have had trouble with my teeth in the past and had to have a root canal at 16, so this post really got me to thinking.

It turns out that I found the name is Ludwig's Angina. The pus generated by the infection forms pockets which grow and cause cellulitis in the face and neck. These pocket of pus cause the airway to close off and sufficate the person. Hence, the life threatening emergency.

Now, the next question for others.....How can this type of infection develope to the point that it's life threatening?

That is the name of it . The ER doctor said he has only seen two cases of this. I had no idea this is what was wrong with my pt. She was intubated and sent to the ICU and was discharged.

[brock8024]

Sometimes we think toothache and blow it off as a stupid call or what ever. the thruth behind it is that a simple toothache could be in fact have a very bad outcome.