EENT Emergencies Flashcards
What is glaucoma?
-Increase in intraocular pressure
-Primarily regulated by the aqueous humour
-The aqueous humour is continually getting replenished and reabsorbed so pressure in
the eye remains constant
-Glaucoma usually results from an imbalance between secretion, flow to the iris and reabsorption
What is aqueous humour?
Transparent fluid that fills the anterior cavity of the eye and nourishes the lens and cornea
What are the risk factors for glaucoma?
-advancing age
-Myopia
-HTN
-Type II DM
What are the clinical manifestations of glaucoma?
-ocular pain
-blurred vision
-enlarged/fixed pupils
-red eyes
-corneal edema (hazy appearance)
-significant headache with associated nausea/vomiting
What complications can occur due to glaucoma?
-Leading cause of irreversible blindness, caused by degenerative damage to the retina and optic nerve
-Retinal detachment
What is retinal detachment?
-Separation of the retina from the epithelium
-Occurs when a tear allows fluid (usually vitreous) accumulates between the two layers (retina and epithelium)
What are the risk factors for retinal detachment?
-advancing age
-HTN
-myopia
-intraocular tumours
-diabetes
-previous eye surgeries
-family hx of retinal detachment, congenital eye disease (glaucoma, cataracts), abnormal vitreous body
What are the clinical manifestations of retinal detachment?
-Usually a gradual progression
-Painless changes in vision (flashing lights/sparks followed by floaters or spots in the field of vision)
-Progresses to the perception of a shadow or “dark curtain” across the field of vision
-Usually begins in the periphery and spreads circumferentially
-If left untreated, can result in permanent vision loss or blindness
What is cataracts?
lens opacity that interferes a with the transmission of light to the retina
What is conjunctivitis?
inflammation of the conjunctiva (pink eye)
What is macular degeneration?
degenerative changes in the central portion of the retina (the macula)
What is myopia (nearsightedness)?
when the eyeball is too long (relative to the cornea and lens)
What is hyperopia (farsightedness)?
when the eyeball is too short
What is corneal trauma?
-Hydration of the cornea is important and must be kept within a limited range
-Damage to surrounding epithelium can cause corneal edema and loss of transparency
-Wearing contact lenses for too long can cause corneal edema, physical trauma causing minor abrasions to the cornea can be extremely painful but typically heals on its own
-Significant damage to the cornea can produce scar tissue post recovery leading to potentially permanent visual impairment
What is hyphema?
-A collection of blood in the anterior chamber of the eye
-Usually caused by blunt trauma to the eye but may also occur spontaneously in patients with decreased coagulability
What is otitis externa (swimmer’s ear)?
-Inflammation of the external ear caused by infectious agents, irritation or allergic reaction
-Bacterial infections are the most common cause
-External Ear - pinna, external auditory canal, tympanic membrane
What are the clinical manifestations of otitis externa?
-Pain
-Itchiness
-Redness
-Tenderness
-Discharge
-Impaired hearing
-Narrowing of the external auditory canal
What is otitis media?
-Inflammation of the middle ear usually caused by infectious process
-Middle Ear - auditory ossicles (malleus, incus, stapes), and eustachian tube
-Typically caused by a disorder of the Eustachian tube that allows reflux of fluid and bacteria into the middle ear
What are the clinical manifestations of otitis media?
-Otalgia (earache)
-Fever
-Otorrhea (ear discharge)
-Hearing loss
-Middle ear inflammation (pain, etc.)
-Perforation of the tympanic membrane
What is vertigo?
A disorder of vestibular function causing an “illusion of motion” described as a sensation
of spinning or falling
What is the vestibule?
part of the inner ear responsible for equilibrium
What is objective vertigo?
sensation of the person being stationary with the environment in motion
What is subjective vertigo?
sensation of the person in motion and the environment stationary
What is epistaxis?
-A nosebleed
-Non-traumatic epistaxis is spontaneous in origin and very rarely fatal
-Caused by a ruptured blood vessel within the nasal mucosa
-Can be a symptom of a more severe underlying medical condition: Altered coagulopathy (pharmacological/malignant), hypertension
-Accidentally swallowed blood/blood clots can cause irritation to the gastric mucosa resulting in GI discomfort, nausea, vomiting
What is rhinosinusitis?
-Inflammation of the nasal sinuses
-Paranasal sinuses are cavities within the facial bones that are lined with ciliated respiratory epithelium
-Connect to the nasal cavity through narrow openings called ostia
-Sinuses are labeled after the bone in which they are located: frontal, ethmoid, maxillary, and sphenoidal
-Commonly develops during an URTI that causes mucosal swelling, obstructs the ostia, and impairs mucociliary clearing
What are the clinical manifestations of rhinosinusitis?
-Facial pain
-Headache
-Purulent nasal discharge
-Decreased sense of smell
-Fever
What is an abscess?
a collection of pus that is restricted to a specific area in tissues, organs or confined spaces
What is a dental abscess?
-A dental abscess can form inside the teeth, in the gums or in the bone that holds the teeth
-Usually caused by a bacterial infection caused by tooth decay or an impacted tooth (not grown out of your mouth properly)
Clinical Manifestations:
-Pain
-Redness
-Swelling
-Cold/heat sensitivity
-Head/jaw ache
-Fever
What is a dental fracture?
-A fractured, cracked or chipped tooth as a result of trauma
-Can cause pain, inflammation, and may progress to abscess formation if left untreated
-May present a choking hazard or cause oropharyngeal/gastrointestinal trauma if a piece
is swallowed
What is trismus?
-A spasm of the jaw muscles causing the mouth to remain tightly closed
-Can be caused by: Tetanus, dental disorder/ illness/injury, head trauma, seizures
-Tetanic spasm of the jaw muscles mediated by the trigeminal (V) nerve
-May present a significant airway concern if activated
What is epiglottitis?
-An acute inflammation of the epiglottis, typically caused by a bacterial infection
-Characterized by inflammatory edema of the supraglottic area (epiglottis and pharynx)
-Symptoms arise suddenly and can cause fatal airway obstruction and asphyxia if not
treated immediately (within hours)
What are the clinical manifestations of epiglottitis?
-Pale, lethargic and distinct position (sitting up, mouth open, chin thrust forward)
-Difficulty swallowing causes drooling and muffled voice
-Moderate to severe dyspnea
-Stridor, nasal flaring, sternal retractions (accessory muscle use)
-Febrile
What is tonsilitis?
-An inflammation of the tonsils caused by an infectious process
-A common occurrence in children, teenagers and young adults
-Causes sore throat, dysphagia and fever
What is a peritonsillar abscess?
-An abscess behind the tonsil
-Typically a complication of tonsillitis and most commonly caused by an infectious process
-Not a very common problem provided that antibiotics are used to treat tonsillitis
-If left untreated, swelling and inflammation can cause airway obstruction
What is a retropharyngeal abscess?
-An abscess in the back of the throat caused by an infectious process
-Can produce: Dysphagia, stiff neck, muffled voice, drooling, fever
-If swelling becomes significant may produce airway compromise and stridor
-More common in children
What is a tracheostomy?
-A surgical, semi-permanent or permanent opening in the anterior neck through to the trachea
-A tracheostomy tube is placed in the stoma (whole/opening in the body) to provide a pathway for breathing
-Surgical procedure – tracheotomy
-There may be many reasons for the insertion of a tracheostomy including: Throat cancers, trauma, neurological compromise, anatomical abnormalities
What is anemia?
-An abnormally low number of circulating red blood cells OR level of hemoglobin OR both
-Results in a diminished capacity for oxygen transport
-Blood loss Anemia, destruction of RBCs, defective RBCs, inadequate RBC production
What is blood loss anemia?
-Loss of RBCs due to hemorrhage produces a decrease in the total quantity of hemoglobin and decrease in the ability to transport O2
-Symptoms and progression depend on whether the hemorrhage is acute or chronic
-Acute - decreased vascular volume results in hypovolemic shock and decreased circulating O2
-Chronic - doesn’t typically affect volume (RBCs lost are rapidly replaced)
-Rapid replacement RBCs quickly deplete iron levels, so they have little to no hemoglobin
What is hemolytic anemia?
-Caused by the premature destruction of RBCs, usually due to an irregularity in the RBC or Hgb
-The ineffective RBCs get phagocytized
-Hemolytic anemia may be inherited or acquired
-Sickle Cell Disease is an inherited disease that results in malformed and ineffective RBCs
-Some acquired forms of hemolytic anemia include autoimmune disorders
What is deficiency anemia?
-Results from the decreased production of erythrocytes by the bone marrow
-May be a direct result of the failure of the bone marrow or a deficiency in the requirements for erythropoiesis (ie. low iron)
What is aplastic anemia?
decreased functional bone marrow causes a decrease in the production of all formed elements
What is iron deficiency?
usually a result of nutritional deficit or blood loss but may result in an increased demand for iron elsewhere in the body (pregnancy)
What are the clinical manifestations of anemia?
-Fatigue
-Weakness
-Dyspnea (severe on exertion)
-Pallor
-Confusion/altered LOA
-Compensatory symptoms (tachycardia, tachypnea, palpitations)
-Decreased SpO2 (significant on exertion)
-All symptoms may be significantly amplified with minimal physical exertion
What are bleeding disorders?
-Bleeding disorders result when the blood lacks, or has impaired function of, certain clotting factors
-They are almost always inherited but may be acquired
-Most common forms include: Hemophilia (A and B) and Von Willebrand Disease
What are clotting factors?
Plasma proteins that are crucial in the clotting process
What is Disseminate Intravascular Coagulation (DIC)?
-Not a primary disease, but a complication of a wide variety of conditions: burns, trauma, acidosis, shock, infections, hypotension, etc.
-Results in massive, systemic, activation of the coagulation sequence
-The systemic coagulation produces significant quantities of microthrombi that cause vessel occlusion and tissue hypoxia
-This also uses up all available coagulation proteins and platelets, causing potential severe hemorrhage
What is Acquired Immune Deficiency Syndrome (AIDS)?
-The disease caused by infection with Human Immunodeficiency Virus (HIV)
-A chronic illness characterized by profound immunosuppression with associated infections, malignancies and CNS degeneration
What causes AIDS?
-HIV is a retrovirus that attacks the T helper cells responsible for coordinating immune responses
-Progressive deterioration of the immune system leaves the patient susceptible to severe infections from normally harmless pathogens
-Body manages to fight off the HIV virus quite well but, due to its persistence, the virus remains and eventually, over years, the amount of T-helper cells begins to decline and eventually the virus prevails
-An HIV infection becomes AIDS when the CD4+ count becomes very low (10-15 years from onset of infection)
-Virus itself does little to cause symptoms/harm to the patient; it is the secondary infections that produce symptoms and mortality
How is AIDS transmitted?
-HIV is transmitted through sexual contact, blood-to-blood contact or perinatally
-Infected semen and vaginal fluids that may come in contact with any vascular mucous membranes
-t’s blood-borne nature makes it imperative to always be vigilant and wear appropriate PPE
-Patient is infectious regardless of symptoms
What is tuberculosis (TB)?
-An infectious bacteria that can infect any organ but most often involves the lungs -thrives in an oxygen rich environment
-Transmitted by respiratory droplets (minute particles in water) from contaminated
people: talking, sneezing, coughing
-After recovery, the pathogen can remain dormant in the patient for years and can reinfect or transmit if the patient becomes immunocompromised
What are the clinical manifestations of TB?
-Initial onset can be insidious (fever, weight loss, fatigue, night sweats)
-Can progress to: high fever, pleuritis and lymphadenitis
-Initially dry cough but can become productive with purulent or blood-tinged sputum
-Dyspnea and orthopnea with rales (fine crackles) on auscultation
What is influenza?
-Viral upper respiratory tract infection (Type A, B and C)
-Infection rates are highest in children and older adults
-Very contagious - transmission occurs via droplet contamination
-Virus targets and kills cilia and epithelial cells in the upper respiratory tract
-Can progress to the lower tract causing damage to bronchi and alveoli
-Inhibiting the innate immunity of the respiratory tract leaves the patient open to secondary infections
What are the clinical manifestations of influenza?
-Fever and chills
-Malaise
-Muscle aches
-Headache
-Watery nasal discharge
-Non-productive cough (dry)
-Sore throat
-Rhinotracheitis
What are antibiotic resistant infections?
-Antibiotic resistance occurs when bacteria change in response to antibiotic medications
-These mutated bacteria become increasingly more difficult to fight
-There is a rising culture of over prescribing antibiotics and not allowing our own innate
and adaptive immunity do their jobs
-This problem can lead to the development of “superbugs” (MRSA, VRE, CRE, certain E.coli strains, C. diff)
What is Meningococcemia?
-Meningococcal Septicemia/Sepsis
-Infection with meningococcus (one of the main bacteria that causes meningitis) that spreads to the blood stream
-Bacteria multiply in the blood stream and causes systemic damage to blood vessel walls and target tissues/organs
-Presents same as meningitis but with associated signs of sepsis
What is sepsis?
a medical emergency that describes the body’s systemic immunological response to an infectious process that can lead to end stage organ dysfunction and death
What is septicemia?
a bacterial infection in the blood stream that can cause sepsis
What is SIRS (Systemic Inflammatory Response Syndrome)?
a systemic inflammatory response to a variety of illnesses or injuries
What is SIRS criteria?
(2 or more of the following):
-HR > 90bpm
-RR > 20bpm
-Temp >38oC/<36oC
-Elevated WBCs
-Prehospital: low ETCO2 correlates to high risk of sepsis
What is tetanus?
-A bacterial infection that produces painful muscle contractions and trismus
-The bacteria release a neurotoxin that travels to the central nervous system and interferes with neurotransmitters involved in muscle contraction
-Transmitted from contaminated soil, dust and feces making direct contact with an open wound
What are the clinical manifestations of tetanus?
-Muscle spasms (painful)
-Dysphagia
-Opisthotonos (muscle spasms causing backward arching of the head, neck and spine)
What is varicella/chicken pox?
-A common communicable childhood disease caused by the varicella-zoster virus (same virus that causes “shingles”)
-Causes characteristic skin lesions that develop rapidly
What are the clinical manifestations of chicken pox?
-Lesions
-Pruritis
-Cough
-Runny nose
-Febrile
-Photosensitivity (rare)
What is varicella/shingles?
-When a primary infection of chickenpox is “defeated”, the varicella virus remains dormant in the nervous system
-Later in life, and especially in immunocompromised people, it is possible for the virus to become reactivated
What are the clinical manifestations of shingles?
-Produces fever
-Malaise
-Headache
-Periorbital pruritis
-Development of a progressive rash that usually isolates to “patches” that may or may not develop crusty skin lesions
-May or may not affect the eyes
What is rubella?
-A mild disease similar to measles that produces a rash and other mild cold symptoms
-Rash typically starts in the trunk and spreads to the limbs
-Spreads via close contact
What is West Nile virus?
A viral infection transmitted mostly via bites from infected mosquitos and then subsequent human to human contact
What are the clinical manifestations of West Nile Virus?
-Fever
-Headache
-Malaise
-Body aches
-Nausea
-Vomiting
-Occasional skin rash
-Severe disease may develop meningitis, encephalitis and paralysis
What is toxic shock syndrome?
-Similar to septic shock, the development of TSS occurs when bacteria release toxins that cause direct harm to vasculature and target organs/tissues
-Septic Shock - result of inflammatory/immune response
-Toxic Shock - direct result of exo/endotoxin damage
-Toxin - substances that alter the normal function of the host’s cells
What are the clinical manifestations of TSS?
-Fever
-Chills
-Malaise
-Headache
-Fatigue
-+/- rash
-N/V/D
What is a neoplasm?
an abnormal mass of tissue in which the growth exceeds, and is uncoordinated with, that of normal tissues
What does the suffix -oma mean?
the suffix added to the parenchymal tissue from which the growth originated (ie. osteoma, neuroblastoma)
What is a benign neoplasm?
usually do not cause death unless their location or size interferes with vital functions. Expand and grow but does not spread.
What is a malignant neoplasm?
invade and destroy tissues and spread to other parts of the body
