Sepsis from Mediastinitis: A Rare, But High-Mortality Condition

Abstract

Abstract This resource is a high-fidelity simulation case designed for emergency medicine residents and medical students. The case involves a patient who presents with chest pain, fever, and lethargy. Upon careful history taking and physical examination, the patient's left molar pain and swelling can be noted. He also has chest wall crepitance. The patient is septic from mediastinitis secondary to an odontogenic process. This case requires recognition of sepsis, identification of mediastinitis, and initiation of appropriate treatment and management including emergent surgical consultation. Mediastinitis is a relatively rare but high-mortality process and emergency medicine providers should have knowledge of its diagnosis and management. This case underscores the importance of a thorough search for the cause of sepsis and also serves as a platform to review mediastinitis and its presentation, diagnosis, and management. This case was implemented with emergency medicine residents and rotating medical students. Feedback was overwhelmingly positive. Participants commented that this case allowed them to review a disease process that they don't often encounter and don't always think about immediately, especially with a septic patient. From the debriefing, they stated that they now have a better understanding of directed history to ask patients in whom mediastinitis is a consideration.

Keywords

• Sepsis
• Odontogenic Infection
• Mediastinitis