Doctor, my throat is closing, I cannot swallow!

Author: Rabia Mustasim, Riad Hosein / Editor: Sarah Edwards / Codes: EC12, EC14, EP6, SLO1, SLO2, SLO3, SLO4 / Published: 18/07/2023

A 34-year-old man presents to the Emergency Department (ED) feeling unwell for the past three days. He has a hoarse voice and increasing neck pain. He feels he cannot swallow and has not been able to eat much.

The patient feels dehydrated and has a fever. He is maintaining an upright posture and says, ‘Doctor my throat is closing I can’t swallow.’ He denies having any previous respiratory problems. He has not had any recent dental procedures but has overall poor dental hygiene.

On examination, uvula is central, and tonsils are normal. You notice mild swelling on the left-side of the neck, left submandibular lymph nodes are swollen and tender, floor of the mouth also has slight tenderness, tongue seems elevated, and the patient has difficulty in swallowing. His chest sounds clear, and his heart rate is fast but regular with no murmurs. No urticarial rash was found.

Overall, he looks dehydrated and toxic. His observations are:

• SpO2 95% on room Air
• HR 125
• BP 100/60
• RR 18
• T 38.4