EM Quick Hits 32 Checkpoint Inhibitors, Adult Epiglotitits, HSP, Heat Stroke, Bell’s Palsy and Leukemia
Emergency Medicine Cases - En podcast af Dr. Anton Helman - Tirsdage
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Topics in this EM Quick Hits podcast Walter Himmel on new diseases associated with immune checkpoint inhibitors (00:54) Leeor Sommer on the evolution of epiglottitis - adult epiglottitis clinical pearls (15:40) Sarah Reid on how to pick up HSP (23:12) Anand Swaminathan on an approach to management of heat stroke (31:02) Justin Morgenstern on the association between pediatric Bell's palsy and leukemia (37:12) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Anton Helman Cite this podcast as: Helman, A. Morgenstern, J. Himmel, W. Sommer, L. Reid, S. Swaminathan, A, H. EM Quick Hits 32 - Checkpoint Inhibitors, Adult Epiglottis, HSP, Heat Stroke, Bell's Palsy and Leukemia. Emergency Medicine Cases. August 2021. https://emergencymedicinecases.com/em-quick-hits-september-2021/. Accessed [date]. Checkpoint inhibitors and their immune related diseases: What we need to know about the "mabs" * Checkpoint inhibitors (easily identified on a patient's medication list as they end in the syllable "mab") are immunotherapy drugs that have been shown to be effective in treating some malignancies such as melanoma * They cause immunosuppression which can lead to inflammatory conditions such as dermatitis, colitis, myocarditis, iritis, arthritis, pneumonitis, thyroiditis and aseptic meningitis * The first presentation of these checkpoint inhibitor related inflammatory conditions are often dermatologic (eg. eczema, DRESS syndrome, Stephens-Johnsons) usually 2-4 weeks after starting the checkpoint inhibitor or gastroenterologic (e.g. colitis); other "mab"-related disease may present months after starting the medication * The management of these diseases usually involves stopping the checkpoint inhibitor, starting steroids and consulting their oncologist Expand to view reference list König D, Läubli H: Mechanisms of Immune-Related Complications in Cancer Patients Treated with Immune Checkpoint Inhibitors. Pharmacology 2021;106:123-136. The evolution of epiglottitis to an adult disease - key clinical pearls * Epiglottitis is an adult disease: while epiglottitis has been classically taught as an acute onset, rapidly progressive pediatric emergency with obvious clinical features, in the post-H.Influenza vaccine era, epiglottitis has emerged as an uncommon (1-3 per 100,000 patient encounters) predominantly adult disease with an indolent onset (usually present on day 3 or 4 of illness) that may present to the ED with subtle findings and be more difficult to diagnose, but carries a higher mortality rate in adults than in children * The predominant complaint is sore throat in 94% of patients, 80% dysphagia/odonophaagia, 60% fever * The symptom that should raise your suspicion of epiglottitis is throat pain out of proportion to minimal/no pharyngeal findings * Other useful clues include choking sensation on lying supine and "hot potato" voice * The use of flexible nasopharyngoscopy to directly visualize the "cherry-red" swollen epiglottis is invaluable in making the diagnosis in the ED and is recommended by our expert to be a core competency skill in our training programs; direct laryngoscopy is an alternative modality to directly visua...