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Urgent Care Guide > ENT 3 > Flashcards

ENT 3 Flashcards

1
Q

epistaxis

A

bleeding from the nasal cavity

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2
Q

epistaxis - anterior and posterior

A

> 90% are anterior
5-10 % are posterior

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3
Q

epistaxis - posterior bleeds are more common in who

A

elderly patients and more difficult to control

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4
Q

epistaxis - hx and clinical presentation
5

A
  1. usually spontaneous
  2. mechanical/chemical irritation (nose blowing, picking, nasal spray)
  3. inherited or iatrogenic coagulopathy
  4. HTN
  5. malignancy
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5
Q

epistaxis - physical exam
6

A
  1. evaluate hemodynamic instability or airway compromise
  2. identify location of bleeding
  3. clear nasal cavity of blood clot
  4. inspect septum and lateral nasal wall
  5. inability to locate bleed is common
  6. consider posterior epistaxis in pts w/ persistent bleeding despite interventions
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6
Q

epistaxis - img/testing
3

A
  1. routine bloodwork/img not needed
  2. consider PT/INR in pts taking warfarin
  3. consider CBC in patients w/ s/sx concerning for anemia or thrombocytopenia
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7
Q

epistaxis - initial mgmt
4

A
  1. bilateral compression of lower 3rd of the nose w/ nasal clip or digits 5-20 mins
  2. +/- topical vasoconstrictor via nasal spray or cotton pledget I.e oxymetazoline (Afrin)
  3. +/- topical anesthetic (lidocaine)
  4. +/- tranexamic acid TXA via cotton ball (10-20 mins then remove)
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8
Q

epistaxis - failed initial mgmt, bleeding site visible

A

chemical cautery - silver nitrate
Anesthesia first with lidocaine 4% cotton ball in both passages x 10 mins. Then remove. Use stick. After tx takes 2 to 3 weeks for healing. Use Vaseline on the cauterized area of the three times a day. Can use saline rinse as well. Slight nosebleeds may be expected but should decrease in time.

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9
Q

epistaxis - silver nitrate tips. Avoid and topical.
2

A
  1. avoid cautery on bilateral nasal septum to reduce risk of perforation
  2. topical anesthetic rec before cautery
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10
Q

epistaxis - failed initial mgmt, bleeding site not visible or topical tx ineffective

A

anterior nasal packing i.e. inflatable balloon, nonadherent gauze

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11
Q

epistaxis - anterior nasal packing tips (f/u and abx)
2

A
  1. f/u in 24-72 hrs for removal
  2. current data doesn’t support systemic abx prophylaxis
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12
Q

epistaxis - when to refer to ER
3

A
  1. persistent bleeding despite anterior packing or concern for posterior bleeding
  2. airway compromise
  3. hemodynamic instability
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13
Q

epistaxis - how to administer rhino rocket
6

A
  1. administer nasal anesthetic is available and Afrin nasal spray (vasoconstrictor)
  2. take rocket out of packaging
  3. sock in sterile water for 30 second or more
  4. insert horizontally
  5. inflate air until pressure gauge is firm but not hard
  6. take excess catheter to face
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14
Q

epistaxis - how to administer marocel

A
  1. administer nasal anesthetic if available and Afrin nasal spray (vasoconstrictor)
  2. take out of package
  3. get tip lubricated i.e. topical abx, petroleum jelly
  4. insert horizontally
  5. soak outside with TXA
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15
Q

sinusitis

A

inflammation of the paranasal sinuses

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16
Q

inflammation of the paranasal sinuses

A

sinusitis

17
Q

sinusitis - URI/virus vs bacterial percentage

A

90-98% caused by a virus URI
2-10% caused by bacteria

18
Q

sinusitis - 3 criteria to distinguish between viral and bacterial
3

A
  1. persistent symptoms > 10 days
  2. severe symptoms - fever >39 and facial pain or purulent discharge >3-4 days
  3. worsening symptoms (fever, HA, or increased discharge) after typical viral URI symptoms lasting 5-6 days
19
Q

sinusitis - physical exam findings
5

A
  1. HA
  2. facial pain/sinus tenderness
  3. nasal congestion/discharge
  4. fever
  5. cough
20
Q

sinusitis - img/testing

A

none usually

21
Q

sinusitis - DD
4

A
  1. viral URI
  2. allergic rhinitis
  3. viral/bacterial sinusitis
  4. migraine
22
Q

sinusitis - abx

A

most are viral and do not req abx

23
Q

viral sinusitis tx
3

A

supportive care
- saline irrigation
- intranasal corticosteroids (intranasal decongestants not recommended) i.e budesonide nasal spray, #1 Flonase, Nasonex (mometasone); 1-2 weeks
- analgesics as needed

24
Q

viral sinusitis - what tx is not rec

A

nasal decongestants

25
Q

viral sinusitis - nasal corticosteroids tx length

A

1-2 weeks

26
Q

bacterial sinusitis - abx for low risk for abx failure (uncomplicated, mild pain, no fever)

A

adults 7 days
augmentin 875 PO BID
doxycycline 100 mg PO BID

peds 14 days
augmentin 22.5 mg/kg PO BID

27
Q

bacterial sinusitis - abx for high risk of abx failure

A

adults 7-10 days
augmentin 875 PO BID
levofloxacin 750 mg PO daily
moxifloxacin 400 mg PO daily

peds 10-14 days
augmentin 45 mg/kg PO BID
levofloxacin 10 mg/kg PO BID

28
Q

bacterial sinusitis - high risk of abx failure include
4

A
  1. endemic resistance of S. pneumoniae to PCN > 10%
  2. recent hospitalization
  3. abx use in past month
  4. immunocompromised
29
Q

bacterial sinusitis - no improvement after 3-5 days of initial tx

A

switch abx class

30
Q

bacterial sinusitis - f/u when

A

48-72 hours after starting abx tx

Urgent Care Guide (38 decks)

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