M&M - Dr. Allen

Case 1 - ACEi AngioEdema

- ACE inhibitors are the number one cause of drug-induced angioedema; other culprits include alteplace, fluoxetine, tacrolimus and rituximab.

- Mainstay of treatment of ACEi-induced angioedema is supportive care and airway protection. FFP, anaphylaxis treatment and other measures have been studied with intermediate results.

Case 2 - Ludwig's Angina

- Ludwig’s angina is infection within the sublingual/submandibular potential space, isolated by superficial fascia. Infection demonstrates rapid progression with posterior deflection of the tongue, obstructing the airway.

- Airway management, ENT consultation and IV antibiotics (penicillin + metronidazole, clindamycin or ampicillin/sulbactam) are the necessary steps for management of Ludwig’s angina.

Severe Mucositis

- Mucositis is a common side effect of most chemotherapy and head/neck radiation regimens that is associated with significant morbidity.

- Severe mucositis carries 75% risk of serious co-infection and 9% risk of  associated mortality.

Ehler's-Danlos and Aortic DIssection

- Ehler’s-Danlos Syndrome, an inheritable collagen vascular disease, is associated with hyperextensible skin and hyperflexible joints; many subtypes are at risk for arterial aneurysm, dissection or rupture at young ages.

- Management of acute aortic dissection or perforation includes vascular surgery consult (for emergent intervention) and decreased BP/sheer stress with IV nicardipine or esmolol.