EENT Emergencies Flashcards
Epistaxis - Anterior vs Posterior Source
Anterior: Kiesselbach’s plexus
Posterior: Sphenopalatine artery
Should be able to visualize anterior bleed
High risk for posterior bleeds: Elderly, anticoagulants, HTN, cancer
Treatment for Epistaxis
Step 1: direct pressure - will not work on posterior bleeds
Step 2: topical anesthetic + vasoconstrictor (Afrin)
Step 3: Determine site of bleeding - kids MC anterior; adults MC right behind Kiesselbach; Older MC posterior
Step 4: Cautery with silver nitrate stick - have to visualize area
Step 5: Anterior Packing - risk of necrosis, TSS
Refer if not controlled -posterior bleed
Septal Hematomas
Occur secondary to trauma to anterior nasal septum
Have to drain and pack
Antibiotics if abscess suspected
Get bilateral hematomas with cartilage fracture
If untreated, get: saddle nose deformity, septal abscess, septal perforation
External Otitis
Edema, erythema of EAC with exudate and tragus tenderness and positive pinna tug
Have to r/o TM rupture, mastoiditis, and malignant otitis externa
Treatment: corticosteroid HC - also reduces inflammation
Malignant Otitis Externa
Can spread intracranially
High risk in elderly and diabetics
Higher degree of pain, whole side of head is swollen
Can be caused by pseudomonas
Systemic antibiotics to treat 6-8 weeks with ENT referral
Otitis Media Treatment
Amoxicillin first line
Augmentin second line
CNS Vertigo
No nystagmus
Hearing loss rare
Presents with other neuro symptoms and rarely other symptoms
Caused by drug toxicity, cerebellar stroke, brain stem stroke
Ear Vertigo
Horizontal nystagmus
Hearing loss
Nausea, vomiting, sweating may occur but no neuro symptoms
Can be caused by Meniere’s, Labyrinthitis, Acoustic neuroma, or Infectious etiology
Meniere’s Disease
Fluctuating, progressive sensorineural deafness
Episodic characteristic definitive spells of vertigo lasting 20 minutes to 24 hours w/o unconsciousness
Vestibular nystagmus always present
Usually tinnitus
Risk are smoking and high-salt diet
Treatment: Diuretics, antihistamines, antiemetics
Acute Labyrinthitis
Recovery takes from one to six weeks
Acute period of severe vertigo and vomiting
Two weeks of sub-acute symptoms and rapid recovery
Treat symptoms
May follow an URI
Benign Positional Vertigo (BPV)
Otolith displacement
Perform Epley’s maneuver to realign the otoliths
Antiemetics and anticholinergics for symptoms
Epiglottitis
Infection/Inflammation of epiglottis and surrounding soft tissue
H-flu, M-cat, strep pneumo, staph
Treat with Rocephin
With MRSA concern, add on clinda or vanco
Peritonsillar abscess
Severe pain, hoarseness, hot potato voice with drooling and dysphagia
Cervical lymphadenopathy, fever
CT to diagnose
Tx is drainage of the abscess with PCN, augmentin, clindamycin
Croup Causative Agent
Parainfluenza virus
Ludwig’s Angina
Cellulitis of sublingual and submandibular areas
Usually from normal mouth flora
Common w/ poor dental hygiene or after dental procedures
Life-threatening - airway obstruction; can develop lockjaw
Submandibular pain, swelling, trismus, and dysphagia with Bull’s neck sign of ant/lateral swollen neck and woody appearance
Have to I&D - surgical emergency
Ocular Emergencies Requiring Immediate Treatment
Acute angle-closure glaucoma
Occlusion of central retinal artery (CRAO)
Orbital cellulitis
Retinal detachment
Acute Angle Closure Glaucoma
Sudden increase in IOP due to block of outflow channels by iris root
Severe pain, halos around light, blurred vision, photophobia, N/V
Affected eye is red, nonreactive midrange pupil w/ hazy cornea, and shallow anterior angle
Photophobia caused by not enough pupil constriction
Can occur after being in a dark room
Occlusion of Central Retinal Artery (CRAO)
MC embolic - carotid artery plaque or endocardial vegetation
Retina can die in 30-60 minutes
Sudden, painless unilateral vision loss, usually in older patient
Palor of optic disc w/ retinal edema, boxcar segmentation
Ophthamological emergency
Orbital Cellulitis
Acute infection of orbital tissues - strep penumo, staph aureus, h-flu
Starts in ethmoid sinus and spreads to subperiosteal lining of orbit through the ethmoid bone
Periorbital edema, exophthalmos with limitation in cardinal field of gaze
EOMs w/ pain - muscular involvement; blurred disk margins, wbc elevated and fever present
Retinal Detachment
Actual separation of neurosensory layer from retinal pigment epithelium
MC in older and myopic patients - may becomes bilateral
Painless decrease in vision with flashes of light and sparks
IOP normal to low, detached retina appears gray with white folds
Admit bilateral patch and ophthalmology
Bacterial Conjunctivitis
Minimal itching with moderate tearing and profuse exudation
Worry about contacts - corneal ulcers
Treatment - Non-contact users: Erythromycin, Trimethoprim-polymyxin; Contact users: ofloxacin, ciprofloxacin
Treatment of Viral and Allergic Conjunctivitis
Viral: antihistamine/decongestant drops
Allergic: antihistamine/decongestant drops, mast cell stabilizer/antihistamine drops
