ENT Flashcards
What should you document when you look in the ENT area?
No trismus, no stridor, handling secretions well, normal respiratory mechanics (aka no respiratory distress)
What is Ludwig’s Angina?
cellulitis/abscess to bilateral sublingual and submandibular spaces. With rapid progressive swelling of the neck
Who is at the biggest risk of Ludwig’s angina?
Immunosuppressed & those with bad teeth
What’s the key thing to remember with Ludwig’s angina?
Look at the floor under the tongue – if it is swollen and red intubate ASAP
How do you treat Ludwig’s?
PCN G 24 million units + Flagyl (of clinda)
You MUST secure an airway for Ludwigs, what airway is most common for them?
Trach… unless you would have intubated them immediately once you suspect it (in 30 mins they will fall)
Wouldn’t do a cracheotomy since the mid neck is completely swollen
If a patient with trismus, stridor, drooling, and talking in 2-3 words sentences but you look in the mouth and it is totally normal, but their neck hurts – what diagnosis?
Retropharyngeal abscess (or epiglottitis)
How would the voice of a retropharyngeal abscess sound?
Like a hot potato!
What is the most common age group you see retropharyngeal abscess in?
Used to be children (since we vax for hemophilus)
Now it’s mid-later aged adults who were never vax
How do you work up a retropharyngeal abscess?
Soft-tissue Lateral neck xray (trachea anterior to abscess)
But it’s sub-glottic so you don’t have the same concern for the airway when you view it (like in epiglottitis)
How do you treat retropharyngeal abscess?
Oxacillin or cephalosporin
If a patient has a significant problem with trismus (difficulty opening the mouth) – what diagnosis is this most common in?
Epiglottitis (again a hot potato voice)
What are the pathogens that cause epiglottitis?
Haemophilus influenza type B
Who do we commonly see epiglottitis in?
Disease of unvaccinated children
What would you see on xray with epiglottitis?
Thumb sign
How do you treat epiglottitis?
Cefuroxime, ceftriaxone, Bactrim
Steroids
If you see a uvula displaced to one side and the person has a sore throat, with possible stridor, drooling, and trismus, what do you think of?
Peritonsillar abscess
How do you treat a peritonsillar abscess?
Drainage and Abx (pen VK)
When you drain a peritonsillar abscess what do you need to be concerned about?
Their internal carotid
What are the take home points for Life Threatening ENT conditions?
Diagnosis less important than recognition of warning signs
Trismus, stridor, respiratory distress, unable to handle secretions
Document lack of warning signs if no concern
Definitive airway early
Where is the first & last tooth, when numbering?
First = Top back right
Last = Bottom back right
How many teeth are on the top?
16
If a patient presents with dental pain with asymmetrical facial swelling but no stridor, trismus, or difficulty breathing. The swelling is in between the teeth and the cheek – what diagnosis?
Abscess
How would you treat a dental abscess?
Drainage (just a little nick!) & Abx (PCN or Keflex)
How else can you control dental pain besides giving pain meds?
Give a dental block (periapical, infraorbital, inferior alveolar)
If you use Marcaine it will take longer to start but will last much longer than lido
If you break a tooth you need to have a filling, but what if it’s Friday night?
They sell temporary dental filling at the pharmacy (without Rx) until they see a dentist
If a patient presents with ear fullness and pain or fussy/inconsolable child – what diagnosis do you think of?
OM
What Abx do we use for OM?
Amoxicillin
Besides Abx, what else can you do for OM?
Aralgan (or benzocaine otic) drops
If you have a perforated TM – what should you not do?
no drops or anything goes inside the ear!
When you suspect OM, what should you always do on PE?
Examine/percuss the mastoid!!
What’s the fear with mastoiditis?
Infection can go to the brain = meningitis
What typically causes otitis externa?
S. aeruginosa & S. aureus
How does the PE differ from OM and OE?
The tragus is uncomfortable with a narrow canal & debris = otitis externa
What do you treat OE with?
Polymixin (Abx/steroid/fungal combo) + wick
What type of nerve palsy can you get with mastoiditis?
CN VI, VII, and V
What would cause mastoiditis?
S. pneumo, Group A Strep, S aureus, M catarrhalis
What age? does mastoiditis most often present?
6-13 months
What subtle PE findings will you see with mastoiditis?
Lack of crease behind the ear
What should you always document with nasal trauma?
The presence or absence of a septal hematoma
How do you treat a septal hematoma?
Call ENT, and most likely drain → ENT f/u
If you suspect a nasal FB in a patient, what do you always need to check for?
always assess for possibility of aspiration of other FB
What’s a great technique to remove a marble from a child’s nose?
Foley catheter
If an elderly person has epistaxsis, what should we ask about their history?
Are they on a blood thinner
Where should you look for on PE with epistaxis?
Look in the back of throat to see if blood is pouring down the throat
Where’s the most common place to bleed in a nose?
Hassel bach’s plexus (anterior)
If it’s a posterior bleed how do you treat?
Call ENT
How do you treat epistaxis?
Vacoconstrictors (medical grade cocaine)
Clamps
Inserted devices (nasal tampons)
Cautery
If you pack someone’s nose what else do they need?
Abx!!
And stuff it STRAIGHT back (not at an angle)
What if the nose bleed has stopped by the time you see them?
Can give meds & clamp for if it bleeds again later tonight
When’s the most common time to see nose bleeds?
November
If your patient has a sore throat with posterior lymph adenopathy – what diagnosis?
mono
IF a patient has a sore throat with anterior lymph adenopathy – what diagnosis?
strep
If you suspect mono what else do you need to check?
Spleen! See if it’s tender
What will you see on PE with strep throat?
White bilateral exudate, red mucosa, and uvula midline
What will you see on PE for mono?
Exudate often gay, huge swelling
If you start a patient on amox with mono – what can occur?
Rash
What will mono respond well to?
Steroids
How do you treat strep?
Amox; magic mouthwash; salt water gargles
