The EM Educator Series: More Than Just Dental Pain

Author: Alex Koyfman, MD (@EMHighAK) // Reviewed by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case:

A 52-year-old male presents with sore throat and tongue pain. Several days ago he had some dental work, and his past medical history includes diabetes and hypertension. On exam, the floor of his mouth is elevated and indurated. He is febrile and tachypneic.

Considerations:

• What are the early and late presentations of Ludwig’s angina, and how do they differ?
• What are the common bugs that cause Ludwig’s, and what antibiotics are recommended?
• What is the ED work-up, and who is safe for CT?
• What is the ED management? What are some considerations regarding the airway?

Suggested Resources:

#FOAMed Articles:

• Life in the Fast Lane – Ludwigs Angina
• emDocs – Ludwigs Angina
• Life in the Fast Lane – ENT Equivocation
• emDocs – Awake Inubation

Podcast/Video:

• EM in 5
• EMCrit – Awake Intubation

Pubmed Article:

• EM Clin North America – Dental and related infections
• EM Clin North America – Infections of the neck