10) ENT & Opthalmic Flashcards
Who does retropharyngeal abscess occur in?
96% occur in children <6 years of age & immunocompromised adults
-beleived to originate from an infected lymph node and progress to cellulitis and ultimately abscess formation
Common pathogens in retropharyngeal abscess
polymicrobial infection
strep, s. aureus, prvotella, bacteroides, peptostrepto, fusobacterium
Imaging in retropharyngeal abscess
CXR = mediastinal extension CT = more sensitive and better delineates the extent of the disease
Peritonsillar abscess
- believed to originate from an infection of the palatine tonsil that invade surrounding tissue
- polymicrobial
- hot potato voice (aka muffled)
Tx of peritonsillar abscess
needle aspiration or I&D
-if not as severe = abx, analgesics, close follow-up
Most common age of epiglottitis
2-6y/o
Most common pathogens of epiglottitis
s. pyogenes, s. pneumo, s. aureus
b/c of HIB vaccine
Epiglottiis on X-ray
thumb sign
Tx of epiglottitis
Maintain airway
-IV fluids, humidified O2, IV abx, steroids, ?heliox (helium and oxygen)
What is Ludwig Angina
cellulitis of the floor of the mouth and neck originating in the submandibular space
**most commonly occurs at the site of dental trauma
Pathogens in ludwig’s angina
- strep
- staph
- peptostrepto
- prevotella
- bacteroides
Tx of Ludwig angina
ensure a patent airway, analgesia, IV abx, otolaryn consult, surgical drainage
Tx of OE
topical antiinflmmatory and antibiotics (polymyxin, neomycin and hydrocortisone)
- use wick if selling obstructs the canal lumen
- *if the TM can’t be visualized oral abx should be considered for presumed concurrent OM
Epistaxis are nearly all located
arterial (anterior = kiesselbach pluxus)
Complications of hyphema
reduced vision, corneal blood staining, acute or chronic glaucoma, synechiae formation (adhesion from the iris to the cornea or lens)
Common cause of hyphema
blunt trauma to the eye
-may also complain of eye pain, decreased vision, or photophobia
Tx of traumatic hyphema
- head elevation, limit eye movements, analgesics, avoiding use of antiplatelets or anticoags
- topical mydriatic, topical steroid, eye sheild
Tx of eleven IOP
topical timolol
oral actezomainde
IV mannitol
(use of these should be guided by an ophthalmologist)
Things to keep in mind w/ corneal abrasion
- tetanus status
- contact lens use (more susceptible to p. aeruginosa)
Tx of corneal abrasion
Tetracaine drops for analgesia
- 2-3 day course of broad spectrum topical eye abx like erythromycin or polysporin
- *if contact wearer: aminoglycoside or fluoroquinolone
- **do not patch
- **do not give tetracaine to go home
- **refer to optham for follow-up in 24h
Central retinal artery occlusion
EMERGENCY: retina ischemai and painless vision loss
- may lead to retinal infarction and irreparable damage if not corrected w/ in 90 min
- *usually presents between age of 50 and 70
Blood supply to the retina
primarily via the internal carotid artery
**thromboembolic events are the most common cause of CRAO
Hx & PE given in CRAO
acute, painless, monocular vision loss
- afferent pupillary defect
- cherry red spot on macula
Tx of CRAO
emergency opthalmologic consultation
-tx is generally tulle if it has persisted for >90min
Periorbital Cellulitis
conjectival injection more common fever commonly present edeamtous erytheamtous periorbital soft tissue EOM non-tender normal IOP normal VA normal sensation tx: abx PO or IV depending on severity = 2 or 3rd gen cephalosporin w/ vanco
Orbital Cellulitis
conjectival injection less common fever commonly present edmatous erythematous periorbtial soft tissue **tenderness w/ EOM **elevated IOP **impaired visual acuity -sometimes impaired sensation tx: often requires surgical drainage --IV 2nd or 3rd gen cephalospoin w/ vanco
About orbital and periorbital cellulitis in general
- tend to be U/L and occur in youth
- *should be tread aggressively to avoid infection extension into the munges and brain via the cavernous sinus
- *most common cause = sinus infections and local skin trauma
Acute Angle Closure Glaucoma
sudeen onset of eye pain, blurred vision, headache, nausea, and vomiting
- *may report halo around lights
- *cloudy or steamy cornea
- *IOP >20mmHg
Tx of Acute Angle Closure glaucoma
Ophthalmology consult emergently
- Pilocarpine 2% = mitotic (until constriction occurs & prophylactically to other eye)
- Timolol decrease IOP w/in 1 hr
- Acetazolamide - reduce IOP w/in 1 hr
- IV mannitol - slowly and temporarily reduce IOP by osmotically drawing water out
