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Abstract：
Ludwig\'s angina is a potentially deadly condition that must not be missed in the emergency department (ED).
The purpose of this narrative review article is to provide a summary of the epidemiology, pathophysiology, diagnosis, and management of Ludwig\'s angina with a focus on emergency clinicians.
Ludwig\'s angina is a rapidly spreading infection that involves the floor of the mouth. It occurs more commonly in those with poor dentition or immunosuppression. Patients may have a woody or indurated floor of the mouth with submandibular swelling. Trismus is a late finding. Computed tomography of the neck soft tissue with contrast is preferred if the patient is able to safely leave the ED and can tolerate lying supine. Point-of-care ultrasound can be a useful adjunct, particularly in those who cannot tolerate lying supine. Due to the threat of rapid airway compromise, emergent consultation to anesthesia and otolaryngology, if available, may be helpful if a definitive airway is required. The first line approach for airway intervention in the ED is flexible intubating endoscopy with preparation for a surgical airway. Broad spectrum antibiotics and surgical source control are keys in treating the infection. These patients should then be admitted to the intensive care unit for close airway observation.
Ludwig\'s angina is a life-threatening condition that all emergency clinicians need to consider. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.
The purpose of this narrative review article is to provide a summary of the epidemiology, pathophysiology, diagnosis, and management of Ludwig\'s angina with a focus on emergency clinicians.
Ludwig\'s angina is a rapidly spreading infection that involves the floor of the mouth. It occurs more commonly in those with poor dentition or immunosuppression. Patients may have a woody or indurated floor of the mouth with submandibular swelling. Trismus is a late finding. Computed tomography of the neck soft tissue with contrast is preferred if the patient is able to safely leave the ED and can tolerate lying supine. Point-of-care ultrasound can be a useful adjunct, particularly in those who cannot tolerate lying supine. Due to the threat of rapid airway compromise, emergent consultation to anesthesia and otolaryngology, if available, may be helpful if a definitive airway is required. The first line approach for airway intervention in the ED is flexible intubating endoscopy with preparation for a surgical airway. Broad spectrum antibiotics and surgical source control are keys in treating the infection. These patients should then be admitted to the intensive care unit for close airway observation.
Ludwig\'s angina is a life-threatening condition that all emergency clinicians need to consider. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.
摘要：
路德维希的心绞痛是一种潜在的致命疾病，在急诊科（ED）不能错过。
这篇叙述性综述文章的目的是提供流行病学的摘要，病理生理学,诊断,以及路德维希心绞痛的管理，重点是急诊临床医生。
路德维希的心绞痛是一种迅速蔓延的感染，涉及口腔底部。它更常见于牙列差或免疫抑制的患者。患者可能有木质或硬结的口腔底部，下颌下肿胀。Trismus是一个迟到的发现。如果患者能够安全地离开ED并且可以忍受仰卧，则优选对颈部软组织进行CT造影。点护理超声可以是一个有用的辅助手段，尤其是那些不能忍受仰卧的人。由于快速气道受损的威胁，麻醉和耳鼻喉科的紧急咨询，如果可用，如果需要明确的气道，可能会有所帮助。ED中气道介入的第一线方法是灵活的插管内窥镜检查，为手术气道做准备。广谱抗生素和手术源控制是治疗感染的关键。然后，这些患者应进入重症监护病房进行密切的气道观察。
路德维希的心绞痛是一种危及生命的疾病，所有急诊临床医生都需要考虑。对于临床医生来说，重要的是要了解有关诊断的当前证据，管理,以及这些病人的性格。
这篇叙述性综述文章的目的是提供流行病学的摘要，病理生理学,诊断,以及路德维希心绞痛的管理，重点是急诊临床医生。
路德维希的心绞痛是一种迅速蔓延的感染，涉及口腔底部。它更常见于牙列差或免疫抑制的患者。患者可能有木质或硬结的口腔底部，下颌下肿胀。Trismus是一个迟到的发现。如果患者能够安全地离开ED并且可以忍受仰卧，则优选对颈部软组织进行CT造影。点护理超声可以是一个有用的辅助手段，尤其是那些不能忍受仰卧的人。由于快速气道受损的威胁，麻醉和耳鼻喉科的紧急咨询，如果可用，如果需要明确的气道，可能会有所帮助。ED中气道介入的第一线方法是灵活的插管内窥镜检查，为手术气道做准备。广谱抗生素和手术源控制是治疗感染的关键。然后，这些患者应进入重症监护病房进行密切的气道观察。
路德维希的心绞痛是一种危及生命的疾病，所有急诊临床医生都需要考虑。对于临床医生来说，重要的是要了解有关诊断的当前证据，管理,以及这些病人的性格。
