EENT Emergencies Flashcards

Question

Orbital Blowout Fracture diagnosis

Answer 1

*Maxillofacial CT scan

Answer 2

*Systemic antibiotic and no blowing the nose *Reassess in 1 week *Patients who present without significant enophthalmos (2 mm or more), a lack of marked hypo-ophthalmos, absence of an entrapped muscle or tissue, a fracture less than 50% of the floor, or a lack of diplopia may not need surgery

Answer 3

*Conjunctivitis *Blepharitis *Canaliculitis *Keratitis *Dacryocystitis *Scleritis *Episcleritis *Corneal Injury *Iritis *Dry eye syndrome *Glaucoma *Subconjunctival hemorrhage

Answer 4

*Decreased visual acuity *Severe, deep eye pain *Ciliary flush * A pattern of injection in which the redness is most pronounced in a ring at the limbus *Photophobia *Severe foreign body sensation that prevents the eye from staying open *Corneal opacity *Fixed pupil *Severe headache with nausea

Answer 5

*Form between the tonsil and capsule *Usually progress from tonsillitis → cellulitis → abscess formation *Weber glands *Mean age is 20-30 years

Answer 6

* Symptoms usually begin 3-5 days prior to evaluation * Fever * Malaise *Headache *Neck pain * Throat pain markedly more severe on the affected side and occasionally referred to the ipsilateral ear *Dysphagia * Change in voice *Otalgia *Odynophagia

Answer 7

* Mild/moderate distress * Fever * Tachycardia * Dehydration * Drooling, salivation, trouble handling oral secretions * Trismus resulting from pain from inflammation and spasm of masticator muscles * Hot potato/muffled voice * Rancid or fetor breath * Cervical lymphadenitis in the anterior chain * Asymmetric tonsillar hypertrophy * Localized fluctuance * Inferior and medial displacement of the tonsil * Contralateral deviation of the uvula * Erythema of the tonsil * Exudates on the tonsil

Answer 8

*Testing is not necessary in straightforward cases *If questionable diagnosis *CT scan

Answer 9

*Pay close attention to the patient's airway *If the patient's airway is compromised, immediate endotracheal intubation is indicated *Fluid resuscitation *Pain medication *Oral steroids *Empiric antibiotics *Clindamycin, Omnicef, or Augmentin *Can cause sepsis or carotid artery erosion if left untreated

Answer 10

* Refer to ENT if needed * The patient should be sitting upright in an examination chair * Spray the tonsil and ipsilateral soft palate with benzocaine (eg, Cetacaine) *Using an 18-gauge needle on a 10-mL syringe, draw up approximately 6-10 mL of lidocaine 1% with epinephrine * Change to a 27-ga needle (preferably a long needle) *Inject the mucosa overlying the fluctuant area with local anesthetic

Answer 11

Clindamycin TID, Percocet, Medrol, tetracaine lollipops

Answer 12

*Acute inflammation in the supraglottic region of the oropharynx with inflammation of the epiglottis, vallecula, arytenoids, and aryepiglottic folds *Haemophilus influenzae (25%) *Noninfectious causes *Reaction to chemotherapy *Thermal (crack cocaine, throat burns in bottle fed infants) *Caustic insults

Answer 13

*Onset and progression of symptoms of epiglottitis is rapid *Sore throat (95%) *Odynophagia/dysphagia (95%) *Muffled voice (54%) - "Hot potato voice" *Adults may have preceding URI symptoms

Answer 14

* Tripod position - Sitting up on hands, with the tongue out and the head forward * Drooling/inability to handle secretions * Stridor: A late finding indicating advanced airway obstruction * Muffled voice (54%) * Cervical adenopathy * Fever * Hypoxia * Respiratory distress * Severe pain on gentle palpation over the larynx or hyoid bone * Mild cough * Irritability * Tachycardia * Toxic appearance of patient

Answer 15

*Direct visualization of the epiglottis *Nasopharyngoscopy/laryngoscopy = ENT *Cherry red epiglottis *The airway should be secured or should be readily securable if endoscopy is performed *Lateral neck soft-tissue radiographs *Avoid radiography for patients in distress until the airway is secure *Swollen epiglottis (thumb sign)

Answer 16

* DO NOT ATTEMPT DIRECT VISUALIZATION OF THE EPIGLOTTIS * Reflex laryngospasm * Airway management is the most urgent consideration * Signs and symptoms associated with a need for intubation include respiratory distress, airway compromise on examination, stridor, inability to swallow, drooling, sitting erect, and deterioration within 8-12 hours * When in doubt, securing the airway is the safest approach * 18.1% require airway management * Patients without signs of airway compromise may be managed without immediate airway intervention by close monitoring in the intensive care unit (ICU) * Avoid therapy such as sedation, inhalers, or racemic epinephrine * Close contacts of patients in whom Haemophilus influenzae type b is isolated should receive rifampin prophylaxis (20 mg/kg; not to exceed 600 mg/d for 4 d)

Answer 17

*Bacteria from the tooth can extend into the gums, the cheek, the throat, the tissues beneath the tongue, or even into the jaw or facial bones *Pus often collects at the site of the infection as the immune system tries to keep the infection from spreading *Can result in death if it spreads to the brain, causes septicemia, or if swelling obstructs the airway *A gum or gingival abscess is the result of infection or trauma to the surface of the gum tissue *Periodontal abscesses are the result of an infection that has moved deeper into gum areas *Periapical abscess refers to a tooth with an infection of the dental pulp

Answer 18

*Pain, swelling, redness *One or more teeth will be very sensitive to pressure *Nausea/vomiting *Fever/chills *Difficulty swallowing *Difficulty opening mouth *Difficulty breathing *Dehydration

Answer 19

*Swelling *Warmth *Erythema *Fluctuant mass *Extends toward the buccal side of the gum and to the gingival-buccal reflection *Parulis *Trismus *Necrotizing fasciitis *Teeth *Most frequently the lower third molar, followed by other lower posterior teeth *Increased mobility *Tenderness with percussion *Extrusion

Answer 20

*No labs indicated for uncomplicated abscess *If accompanying cellulitis *Leukocytosis with neutrophil predominance *Aerobic and anaerobic blood cultures prior to IV antibiotics *Panorex dental x-rays- not done in the ER *Lateral and neck x-rays *CT scan *Needle aspiration *1-2 drops

Answer 21

Treatment *Assess the airway and secure if necessary *Cultures *Antibiotic *Oral vs. IV *Hydration *Pain management *I & D *F/u discharge referrals *Uncomplicated → dentist *Complicated → maxillofacial oral surgeon/ENT

Answer 22

*Rhinotillexis/mucophagy *Dry climate *Supplemental oxygen *Nasal anatomy *Trauma *Coagulopathy *Foreign body *Iatrogenic *Infection

Answer 23

*Anterior * 90% of bleeds occur anteriorly * Capillary or venous bleeds * Patients present with a constant ooze or intermittent bleeding that resolves quickly * Posterior * Often of arterial origin * Branches of the sphenopalatine artery * Associated with atherosclerotic disease and hypertension * Patients present with profuse bleeding

Answer 24

Labs and imaging usually not required Treatment of anterior epistaxis * Direct pressure continuously for 15 minutes * Sitting position * Slightly leaning forward * Topical nasal decongestants * Topical 4% cocaine * Silver nitrate * Surgicel * ENT referral if recurrent or persistent

Answer 25

* ENT ER consult * Rigid nasal endoscopy * Cauterize * Rapid Rhino *Antibiotic * F/u with ENT 3-4 days later

Answer 26

*Begins suddenly upon waking *Severe spinning *Episodes are brief, less than 1-2 minutes *Triggered by sudden head movement, often unilateral *Lag period *May have no symptoms between episodes *“Mentally foggy” *Exam usually WNL

Answer 27

*Dix Hallpike *Classic rotatory nystagmus with latency and limited duration *In classic posterior canal BPPV, the top pole of the eyes rotates toward the undermost (affected) ear *Imaging typically not indicated in uncomplicated BPPV that resolves with treatment

Answer 28

* Rehydration *Observation * Benign and can resolve spontaneously * Medication to suppress the vestibular system * Diazepam, meclizine * Canalith repositioning (Epley maneuver) * Vestibular rehabilitation * Patient education * Most cases resolve within 6 weeks * Recurrence rate of 15-20%