ENT Flashcards
What is a quinsy and how does it usually present?
Peritonsilar abscess
- Tonsil is erythematous, exudative, with asymmetrical fullness of the soft palate and uvula deviation to the other side
- Often have trismus and “hot potato” voice, high fevers, appear more unwell +/- toxic
What is the general treatment for a Quinsy?
- ENT consult for aspiration vs ED aspiration
- Dexamethasone 0.15-0.6mg/kg IV
- Benzylpenicillin 50mg/kg QID
- Analgesia, IV fluids
What is the treatment for post tonsillectomy bleeds?
- Sit upright and lean forward
- Vasoactive anaesthetic spray
- Hydrogen peroxide 3% gargle
- 2x large bore IV access
- G+H, PRBC’s, MTP
- Benpen 60mg/kg and Metro
- TXA IV/gargle 1gm
- Direct pressure ie swab on foreceps soaked in cophenylcaine
- Reverse any anticoagulation
- Protect airway
- Urgent ENT review
What are the indications for antibiotics for otitis media?
- Indigenous
- Children <6 months
- Perforation
- Systemic features of infeciton
- Poor access to follow up
- immunosuppressed
- Children 6-24months that have shown no improvement over 24hrs
- Cochlear implant in situ
- Affecting the only hearing ear
When draining a Quinsy, where should the needle be aimed?
Super-medial aspect of the tonsilar swelling, approx 1cm deep
What are the treatment and discharge ecommendations post inferior orbital wall and other sinus injuries?
- analgesia/antiemetics
- Do not blow nose
- Ice for swelling
- Sleep with head elevated
- Oral Augmentin duo
- No diving/flying
- Head injury advice
- Return advice
- Follow up appointment
What are the indications for ENT removal of nasal FB’s in theatre as opposed to ED removal?
- Button batteries
- Bleeding diathesis
- Airway compromise
- Multiple ED unsuccessful attempts
- FB posterior/not easily visualised
- Penetrating/hooked FB
- Chronic or impacted
- Paired magnets on either side of septum
- Resource limitations
- Congenital anatomic abnormality
- Child not fasted
- Parent request
What are the complications of otitis media?
Serious
- Mastoiditis
- Intracranial abscess
- Meningitis
- Sepsis
- Lateral sinus thrombosis
Other
- Facial nerve paralysis
- TM rupture
- Bullous myringitis
- Suppurative OM
- Middle ear effusion
- conductive hearing loss
What is the classic triad of Ramsay-Hunt syndrome?
Otologic VZV
- Can also affect cranial nerves V, IX and X
Triad of ipsilateral facial paralysis, ear pain and vesicles in the auditory canal/auricle
Vertigo, tinnitus, hyerpacusis and changes to taste can also be features
Treated with antivirals and steroids
What are the different types of post-tonsillectomy bleeding?
Primary
- During surgery
Reactionary
- Within 24hrs usually whilst still in hospital
Secondary
- After 24hrs
- Most commonly 5-10 days
- Usually from an infection
- Older children at higher risk (7%)
What are the indications for a Tracheostomy?
- Prolonged mechanical ventilation
- Pulmonary toilet as unable to clear own secretions ie bulbar palsy
- Airway protection
- As part of, or a bridge to a surgical procedure ie neck tumour resection
- Upper airway obstruction
What is the most common cause of massive tracheostomy bleeding and what is the stepwise approach to its treatment?
Tracheo-inominate fistula
- Usually within 3 weeks of surgery
- May have small volume sentinel bleeds, overall very high mortality
1- Hyperinflate the cuff up to 50cc (85% succesful) to tamponade
2- Withdraw tube whilst also placing pressure on anterior neck
3- Intubate from above (as long as anatomically feasible)
4- Stick fingers in and apply digital pressure to the inominate against the manubrium, as bridge to theatre
5- Place a cuffed ETT down trache to prevent aspiration
6- Correct coagulopathies, give TXA and MTP
7- Emergent theatre
What is the general management of a severely dyspnoec/hypoxic patient with a trachesotomy in situ?
- Add high flow 02 over the tracheostomy stoma
- Remove any speaking valve/cap
- Remove the inner cannula and assess it for obstruction
- Pass a suction catheter (carefully) to assess for airway obstruction or secretions
- Deflate the cuff if present
- Intubate the stoma and apply positive pressure ventilation
- If all else fails consider intubation from the top (if anatomically possible) or new surgical airway
What is the treatment and complications of auricular haematomas?
Mx
- Incision and drainage
- Application of compression bolster to prevent re-accumulation
Complication
- Cauliflower ear
How should an intubation be performed when there is upper airway bleeding (ie post tonsillectomy bleed)?
