Badly Swollen Lips… October 30, 2012
Posted by Andy Jagoda, MD in: Gastrointestinal, Respiratory Emergencies , trackback
In the middle of an unusually slow evening shift, a 52-year-old black male presents to the ED from walk-in triage with a complaint of lip swelling. He states that he noticed a tingling in his lips shortly after waking that morning, but it wasn’t until he brushed his teeth that he noticed how large his lips had become. He decided to come to the hospital almost 12 hours later only after family members insisted that he get “checked out.” He denies any recent trauma, infection, or known exposures to possible allergens. He denies any pain or itching. His past medical history is significant for hypertension and borderline diabetes. He is unable to remember the name of the medication that he takes for his blood pressure, but he says he has been taking it for years. His vital signs are: heart rate, 74 beats per minute; blood pressure, 156/82 mm Hg; respiratory rate, 16 breaths per minute; temperature, 36.8C; and oxygen saturation, 98% on room air. He is comfortable and in no apparent distress. It would be impossible to miss the rather impressive size of his lips. The upper lip looks to be about 10 times the normal size and the lower lip is only somewhat less enlarged. You are able to examine his oropharynx and find no further swelling of the uvula or posterior pharynx. The rest of his examination is unremarkable. Your nurse checks the airway cart out of concern that the patient will need to be immediately intubated. Your medical student asks the following logical questions:
- What is the cause of his lip swelling?
- Is there a diagnostic test to determine the cause?
- What is the appropriate treatment?
- Should the patient be intubated immediately to protect his airway?
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