ENT Flashcards
Otitis externa tx
ciprofex or ofloxacin with an otowick
TM perforation management
give ciprodex drops only if infected. have pt keep ear dry and follow up with ENT in 1-2 wks
mastoiditis tx
admit for IV vancomycin + ceftriaxone
management for live FB in ear
viscous lidocaine in ear and flush with syringe. If TM not intact flush with saline
management of sudden onset hearing loss
start high dose, 60mg, PO prednisone and refer emergently to ENT
Management of bells palsy
document full neuro exam- not forehead sparing. give prednisone and acyclovir and eye drops
Management of Mono in ED
+ mono spot, check liver transaminases. supportive care
Management of tonsillitis
r/o strep and mono. if strep give amoxil. supportive care
Management of diphtheria
contact CDC, give anti-toxin and arithromycin. Admit. All contacts require diphtheria booster
management of peritonsillar abscess
aspirate if needed. start on IV vanco + ceftriaxone. If can wait for aspiration send home on abx and schedule aspiration.
management of acute pharyngitis
document if LAD, excavates, stridor, drooling, wheezing and last PO. give PO Pen G or clindamycin
Strawberry tongue ddx
Kawasakis, scarlet fever/strep throat, Toxic shock syndrome
Pt comes in with hot potato voice- tongue is pushed up and back. What does the pt have?
Ludwig angina. Will feel brawny induration on palpitation. Get CT and consult for surgical drainage. PT will be admitted.
imaging findings of retropharyngeal abscess
when the retropharyngeal space at C2 is twice the diameter of the vertical body it is suggestive of an abscess. Contrast CT is test of choice
management of retropharyngeal abscess
consult ENT immediately. Monitor and stabilize airway, obtain IV access and give fluids, clindamycin and CT contrast. May give steroids.
Pt comes in with harsh barking cough and stridor. XR shows steeple sign.
This is croup. Sx worst at 3-4 days of illness.
Most common cause of stridor in 6 mo- 3 yrs
croup
Management of croup
keep child calm, Give nebulized epinephrine and either IV or PO dexamethasone. Must observe in ED for 3 hrs after epi.
admission criteria for croup
Have had 2 epinephrine treatments and are still in distress
Thumb sign
epiglottitis
management of epiglottitis
nasotracheal intubation is preferred if they are in distress. Consult anesthesiology and ENT immediately. Start on clindamycin and give IV methylprednisone or epi. Do not lay the pt down- they should remain upright.
management of sinusitis
sxs > 10 days is indication for tx. Will want to get a CT to confirm if not certain it is sinusitis or to r/o potts tumor if facial edema is significant. can give azithromycin
Management of potts sinusitis
admit for IV abx and surgical debridement. Found on CT
management of nasal injury.
stabilize airway and breathing. Get CT. if mild angulation and no displacement can reduce in the ED. if major deformity refer for f/u with ENT in 2-5 days
management of septal hematoma
will see bluish filled sac at the nasal septum. will need to drain it and place anterior packing but ENT usually does this.
Management of cribriform plate fx
if see halo sign/ copious clear nasal discharge. Stabilize breathing and airway, get a head CT and get a consult
timeline for nasal packing removal
anterior pack 24-48 hrs, posterior pack up to 72 hrs
management of nasal FB
attempt removal with katz extractor. attempt x2 before ENT consult. If alkaline battery do not use saline flush and call ENT right away.
Ellis class 1 dental fx
enamel involvement only. Smooth any sharp edged and refer to dentist
Ellis class 2 dental fx
involves the dentin of the tooth, which is creamy yellow in color. Will cover exposed dentin with ionomer dental cement and refer to see dentist within 24 hrs
ellis class 3 dental fx
Dental pulp is exposed- tooth will not stop bleeding. Will need to cover pulp with calcium hydroxide and then cover that with glass ionomer cement. Urgent dental consult
Dental concussion
injury to the supporting structures of a tooth with clinical tenderness to precision but there is no mobility
Dental Subluxation
Injury to the tooth resulting in mobility but there is not evidence of dislodgment of tooth
Dental extrusive luxation
the partial avulsion or dislodgment of a tooth from the alveolar bone
Dental lateral luxation
displacement of a tooth laterally with fracture of the alveolar bone
Dental Intrusive luxation
displacement of a tooth into its socket with associated alveolar fracture
dental avulsion
total displacement of tooth from socket
Management of dental avulsion
reimplant permanent teeth ASAP- best if in 2-3 hrs. Do not exceed 60 minute dry time
acceptable transport solutions for tooth
balanced salt solution, sterile saline, milk or saliva.
abx therapy for tooth avulsion
Doxycycline PO BID
