EENT Flashcards
Epistaxis
- posterior
- rare
- Spenopalatine artery
- Emergency: foley cath down nose, blow up, clamp, call ENT
Anterior
Epistaxis
- anterior
- Kiesselbach Plexus
- Pinch nose, ice pack
- Phenylephrine spray (Afrin)
- Silver nitrate stick to cauterize if can ID site of bleed
- Rhino rocket: last resort (Michelle)
Angioedema
- MC drug cause: ACEi or ARB
- Hereditary: C1 esterase dysfunction, minor trauma can cause
- Best tx: stop offending agent and admit, watchful waiting and spO2 monitoring.
- Airway!! If need intubation, very difficult
Dental Abscess
- describe
- RF
- Infection of dental pulp
- Poly microbial (mouth)
- RF: poor oral hygiene, low socioeconomic, DM, smoking, substance abuse
Dental Abscess Tx
- Abx (PCN, clindamycin)
- Most do not require I&D, if so, consult ENT
- Pain meds: this is a common complaint of drug seekers, instead offer oragel or clove oil
Dental blocks
- three types
- Infraorbital: upper front teeth and gingiva (aim towards pupil)
- Submental: lower front teeth and gingiva
- Infralveolar: good for molars, only do if well trained
- good way to tell if they are drug seeking: if they turn it away and want meds instead
Ludwig’s Angina
- describe
- true dental emergency!
- Rapidly expanding infection of submandibular space, rare, potentially life threatening
Ludwig’s Angina
- s/sx
- mouth pain
- drooling
- Trismus
- Tongue protrusion
- sublingual edema**
- Neck swelling
- Can look like cellulitis on the outside!
Ludwig’s Angina
- MC cause
- Tx
- MC from odontogenic source, spread from lower molar abscess
- Tx: airway, IV abx, possible sx
Peritonsillar abscess
- describe
- Dx
- Tx
- Commonly triaged as sore throat
- S/sx: One sided pain, trismus, fever, myalgia, raspy voice (hot potato voice), trouble swallowing spit
Dx:
- CBC, BMP, CT neck w/contrast
Tx:
- ENT consult, admit to watch airway, possible sx I&D
- IV fluids, steroids, abx (Clindamycin, Zosyn), salt gargle
Retropharyngeal Abscess
- describe
- Very rare, can looks similar to peritonsillar abscess!
- Lymph drainage dt upper respiratory and oral infections
- Poly microbial, MRSA is increasing cause
Retropharyngeal Abscess
- s/sx
- PE
- s/sx: sore throat, fever, dysphasia, neck pain, dyspnea
- PE: posterior pharyngeal edema, nuchal rigidity, cervical adenopathy, drooling, stridor, trismus, torticollis
- Kids pathopneumonic: retropharyngeal bulge
Retropharyngeal Abscess
- Tx
- Airway (prep for cricothyrotomy)
- ENT consult
- IV fluids
IV abx (clindamycin, zosyn)
Foreign body
- ear
MC: bugs
- If still alive: lidocaine 1% in ear
- Cockroach legs stick to TM
- Easiest method to remove is irrigation
- Dig: alligator forceps
- Low suction great for plastic pieces of hearing aids
Foreign body
- nose
- Smellier = been there longer
- Good nose blow (30% success), mouth to mouth blow for parents to kids
- Katz Extractor: small balloon catheter
- Beware of magnets stuck together: can bleed profusely when take off, get ENT consult for this
Foreign body
- Eye
- Get visual acuity: both eyes for baseline measurement prior to procedure, CYA.
- MC: metal from grinding
Tx:
- 1st: irrigation
- Fluorescein stain, slit lamp exam: allows to see how embedded it is, can see corneal abrasion also
- Invert lid, sweep with Q-tip
- Eye burr
Foreign body
- Throat
- MC: male eating too quickly Tx: - Glucagon (smooth muscle relaxor), Ativan - Should not stay impacted >24 hours - Bones or hard debris: endoscopy (GI)
Swallowed (kids, mentally unstable)
- 2 view XR
- Most will pass
- Emergent GI: batteries, magnets, sharp/pointy
Mastoiditis
• Complications of OM: fluid blocked in mastoid air cells
• Presents with pain, swelling, erythema to postauricular area
- Ear canal should not be involved (OE), might be air or fluid, erythema, purulence behind TM
• Dx: CT w/contrast
• Admit to ENT for IV abx and/or typanocentesis
• Tx: rocephin or levofloxacin
• Differentiate from lymphadenopathy or abscess!
