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January 10, 2006

Fast-Moving Doc Saves an Epiglottitis Patient

Today's NYT has a great story by Jordana Horn Marinoff, describing how an alert MD identified Marinoff's husband's severe sore throat as epiglottitis -- a bacterial infection usually found in small children -- and got Nathan to the ER in time to save his life.

Here's a snippet:
An hour later, Nathan called me from the emergency room. "I need you here."

"I'll be there in about 15 minutes, O.K.?" I said distractedly, balancing the telephone between my ear and shoulder as I turned on the coffeemaker. "The babysitter just got here."

"Well, they're about to intubate me and have me unconscious for a few days, so could you come right away, please?" he rasped.

I drove to the hospital, five minutes away, and ran into the E.R. The doctor was there, along with two anesthesiologists, the chief E.R. surgeon and six nurses.

The doctor said that it was in fact epiglottitis and that Nathan's symptoms were advanced and severe, adding, "If we sedate him and intubate him within the next 10 minutes, the chances of this being fatal are 1 in 100,000."

The intubation, he said, would ensure that his windpipe would remain open and that Nathan could breathe while being given antibiotics.

"And if we don't?"

"We'll either have to do a tracheotomy or he'll die."
They did intubate Nathan, inducing a coma for two days to allow his throat to heal and the tissue to contract, then woke him up. He left the ICU and was back to work the next day.

Jordana and their kids had received the HIB vaccine against Haemophilus influenzae -- the likely culprit in Nathan's illness -- but were given an antibiotic regimen to ensure they wouldn't be silent carriers of the bacteria.

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