EENT Emergencies Flashcards
Epistaxis
- ideal pt positioning
- two MC common sites of bleeding
- Tx
- complications of a posterior bleed
-Ideally, have the pt in a 90 degree sitting position. This decreases nasal arterial pressures, prevents aspiration
MC sites
- Kiesselbach’s plexus (anterior)
- Sphenopalatine artery (posterior)
Tx
- direct pressure
- apply topical anesthetic + vasoconstrictor (afrin and cotton balls soaked in lidocaine)
- determine site of bleeding: need nasal speculum, good illumination, suction
- cautery with silver nitrate stick: need to be able to visualize the bleeding area
- Anterior packing: nasal tampons or nasal balloon catheters, remove in 48-72 hours, oral abx required
- if still bleeding, consider this a posterior bleed and consult ENT emergently
Posterior bleed complications
- difficulty swallowing
- otitis media
- necrosis of the nasal mucosa
- direct pressure is ineffective
- serious things can cause posterior bleeds, so be careful (cancer)
Nasal Fracture
- PE findings
- Dx
- complications
- Tx
PE
-edematous, crepitus, painful, malformation
Dx
- clinical
- xray
- CT if brain trauma, high velocity fx, etc…
Complications
-septal hematoma
Tx
-closed reduction 2-10 days post injury to allow for reduction of swelling
Septal hematoma
- secondary to what
- complications
- tx
Secondary to nasal fracture
Complications
- septal perforation
- necrosis
- saddle deformity
- blocked airway
- septal abscess
Tx
- drain (bedside) and pack
- Abx (augmentin) if abscess suspected IV Clindamycin and admission
Otitis Externa
- aka
- clinical presentation
- PE findings
- Tx
- worry about what
AKA
-swimmers ear
Presentation
-edema, erythema of EAC with +/- exudate
PE
- MUST see TM
- positive pinna tug
Tx
-application of wick and Cortisporin HC, local heat, analgesia
Worry about malignant otitis
Vertigo
- describe each of the following in regards to vertigo cause by a neurologic disorder and vertigo caused by a disorder of the ear
- -nystagmus
- -hearing loss
- -other neuro sx
- -other sx
- -DDX
CNS disorder
- -nystagmus: usually absent
- -hearing loss: rare
- -other neuro sx: present
- -other sx: rare
- -DDX: drug toxicity, cerebellar stroke, brain stem stroke
Ear disorder
- -nystagmus: horizontal
- -hearing loss: usually present
- -other neuro sx: absent
- -other sx: N/V, sweating
- -DDX: meniere’s, labrynthitis, acoustic neuroma, infectious
Vertigo: Meniere’s Disease
- what is this
- sx
- tx
What
-idiopathic distention of endolymphatic compartment of the inner ear by excess fluid
Sx
- EPISODIC vertigo lasting 20 min to 24 hours
- fluctuating hearing loss
- tinnitus and ear fullness
Tx
- sx treatment: antiemetics, steroids
- preventative: HCTZ, avoid satl, caffeine, chocolate, ETOH (because they increase endolymphatic pressure)
Vertigo: Acute Labyrinthitis
- what is this
- acute sx
- how long does recovery take
- tx
What
- inflammation of the vestibular portion of CN 8 in the inner eat PLUS hearing loss/tinnitus
- most common post viral
Sx
- severe vertigo
- vomiting
Recovery
-1-6 weeks
Tx
-corticosteriods*
Vertigo: Benign Paroxysmal Positional Vertigo
- casue
- sx
- tx
Cause
-displaced otoliths
Sx
- episodic peripheral vertigo provoked by changes of head positioning
- dix-hallpike test positive
Tx
- Epley maneuver
- usually doesnt need medication, maybe antihistamines
Acute Tonsillitis
- signs and sx
- MC cause
- Centor criteria
- tx
Signs and sx
-fever, exudate, adenopathy, beefy red
MC cause
- VIRAL
- but for bacteria, group A beta hemolytic strep
Centor Criteria
- tonsillar exudate
- tender cervial LA
- Fever or hx of fever
- no cough
- -the more you have the more likely it is bacterial
- -this is to help decide if they need abx
Tx
- Abx if needed (Penicillin V, Amoxicillin)
- ibuprofen
- fluids
- rest
- can give a quick burst of steroids for pts who cant swallow
Epiglottitis
- What is this
- MC organism
- MC in who
- sx
- dx
- tx
What
-infection/inflammation of epiglottis and surrounding soft tissue
MC organism
- H flu***
- Strep pneumo
MC in children
Sx
- abrupt onset of fever
- drooling
- dysphagia
- distress, tripod position, muffled voice
Dx
- IF YOU SUSPECT, DO NOT EXAMINE, CALL ENT
- lasteral cervical film=thumb print sign
- cherry red epiglottis
Tx
- secure airway*
- IV abx (rocephin +/- clinda)
- IV corticosteriods
- IV fluids
Peritonsillar Abscess
- AKA
- sx
- dx
- tx
AKA
-Quinsy
Sx
- severe pain, hoarseness
- hot potato voice
- drooling
- dysphagia
- trismus
- fever
- cervical LA
- soft palate bulging
- uvula deviation
Dx
-CT of neck
Tx
- Call ENt and take to OR for I and D
- IV abx (high dose PCN, augmentin or clindamycin for PCN allergic pts)
Croup
- MC in what ages
- sx
- tx
MC in children ages 3 months to 3 years
Sx
-hoarse, barking cough
Tx
-racemic epi and call pediatrician
Ludwig’s Angina
- what is this
- MC in what patients or after what procedure
- sx
- tx
What
- cellulitis of the sublingual and submandibular spaces in the neck
- its an abscess!
MC in pts with poor dental hygiene or after dental procedures*
Sx
- can be life THREATENING (airway obstruction, sepsis, infection going into mediastinum)
- submandubular pain, swelling, trismus, dysphagia
- sublingual and submandubular tissues markedly swollen with a “woody appearance”
- tongue is pushed superiorly and posteriorly
- ant/lat neck is swollen/indurated- “bulls neck”
Tx
- refer to ENT
- manage airway
- I and D
- Abx (PCN +metronidazole, clinda)
What ocular conditions require immediate treatment?
What is the first part of the PE preformed on an eye pt?
Acute angle closure glaucoma
CRAO
Orbital cellulitis
Retinal detachment
VISUAL ACUITY AND DOCUMENT
Acute Angle Closure Glaucoma
- what is this
- sx
- PE
- dx
- tx
What
-sudden increase in IOP due to blockage of outflow channels (trabecular meshwork and canal of schlemm)
Sx
- severe unilateral pain*
- halos around light
- blurred vision*
- photophobia
- N/V
- tunnel vision (loss of peripheral vision)
PE
-affected eye is red, nonreactive midrange (often irregular) pupil, hazy cornea, shallow anterior chamber angle
Dx
-tonomerty (greater than 21mm Hg)
Tx
- REFER TO OPTHO
- lower IOP with IV acetazolamide (first line)
