ENT Flashcards
Differences between adult and paediatric airways
- Smaller mandible
- Larger head and occiput
- Bulging occipital process (Flexed neck)
- Tongue is relatively larger
- Epiglottis is longer and floppier
- Larynx is higher and more anterior
- Narrowest part is cricoid ring (until about 5 years)
- Airway is shorter and narrower
- Smaller diameter at airway, therefore, higher resistance to airflow
Causes of paediatrics stridor and their expected stridor qualities
General causes of stridor for varying age groups
Anatomical structures involved in jaw (bilateral TMJ) dislocation + reduction techniques
Mandibular condyle (of mandible) moves anteriorly and out of mandibular fossa (of temporal
bone)
Syringe technique:
- 10mL syringe placed between mandibular and maxillary molars
- Patient to roll syringe anterior and posterior
Manual reduction:
- Gloves/rolled gauze, thumbs placed on mandibular molars
- Firm, constant inferoposterior pressure until reduction
- May require procedural sedation
On discharge:
Simple analgesia
Soft/liquid diet
Avoid yawning and large bites
If recurrent, maxfax review
Only image if traumatic
Clinical signs of occult nasal foreign body
- Foul smelling rhinorrhoea / purulent discharge
- Unilateral epistaxis
- Unilateral nasal obstruction / mouth breathing
- Pressure necrosis
- Septal necrosis especially with battery or paired disc magnet foreign bodies
- Less specific – facial swelling and fever
Nasal foreign body: indications for ENT referral
- Posterior FB not easily visualised
- Chronic or impacted FB with marked inflammation
- Penetrating or hooked FB
- Failure to remove in emergency due to poor cooperation, bleeding, limited instrumentation
Indications for antibiotics in acute otitis media
- <6mo old
- Immunocompromised
- Aboriginal or Torres Strait Islander
- Only hearing ear
- Cochlear implant
- Possible supperative complication
- Nil improvement after 48 hours conservative management
Antibiotics for AOM incl. penicillin hypersensitivity
- Amoxicillin 30mg/kg BD for 5 days
If no improvement at 48 hours:
2. Amoxicillin-clavulanate 22.5mg/kg BD for 5 days
If delayed/non-severe hypersensitivity:
3. Cefuroxime 10mg/kg (3mo-2 years) or 15mg/kg (2 year+) BD for 5 days
If immediate or severe hypersensitivity:
4. Trimethoprim/sulfamethoxazole 4-20mg/kg BD for 5 days
Complications of acute otitis media
Tympanic Membrane Perforation
Mastoiditis
Cholesteatoma
Intracranial Extension
Chronic Otitis media with effusion
Hearing loss
Neck zone boundaries and contents
Zone I: clavicles to cricoid cartilage
- Vascular: Vertebral and proximal carotid artiries; major thoracic vessels
- Airway: Lungs, oesophagus, trachea
- Other: Thoracic duct, spinal cord, superior mediastinum
Zone II: Cricoid cartilage to angle of mandible
- Vascular: carotids, vertebral arteries, judular veins
- Airway: Oesophagus, trachea, larynx
- Other: Spinal cord
Zone III: Angle of mandible to base of skull
- Vascular: Distal carotid and vertebral arteries
- Airway: Pharynx
- Other: Spinal cord
Physical findings of reported strangulation injury requiring further investigation
- Visible local bruising/swelling/petechiae
- Dyspnoea/stridor
- Dysphonia/voice change
- Neurological deficit
- Carotid bruit
- Bony c-spine tenderness
- History of LOC or altered GCS
