Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > ENT > Flashcards

ENT Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

priority imaging in maxillofacial trauma

A

C-spine a priority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

history with facial issues

A
  1. What happened and when
    a. Fall? (why fell?), MVA? Assault?
  2. LOC? Vomiting? Can’t walk?
  3. Visual symptoms?
    - -> IS THE EYE DAMAGED
  4. Facial anesthesia/paresthesia?
    - -> The amt of nerves in your face are no joke
  5. Condition of teeth, bite, blown nose?
  6. PMH, meds (on Coumadin?), tetanus
  7. Police report made?
  8. Domestic Violence? Child abuse?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PE for facial injury -ORAL

A
  1. -Full, gloved exam
  2. -Lips - lacs, hematoma,
  3. Thru/thru, vermillion
  4. -Trismus or can’t close?
  5. -Teeth present and intact?
  6. Where are they?
  7. -Alveolar ridge, frenulum attachment
    –> need to see if this is stable b/c it is differnt than a maxilla fracture
    if that is moving get a CT
  8. -Bleeding in mouth?
  9. -Tongue - lacs? Bleed A LOT!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PE-Eyes

A

• Look from above/below/side for asymmetry
• Whistle, smile, wrinkle forehead
• Eyes
Visual acuity (Rosenbaum card – near card; if they can stand do Snellan)
Periorbital - edema, crepitus, lacerations
EOM’s
Pupils, conjunctiva and anterior chamber
Symmetry, subconjunctival hemorrhage (blood vessel breaks between conjunctiva and sclera, hyphema (blood in ant. Chamber)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PE-nose

A
  1. -Locate, control bleeding
  2. -Nasoseptal hematoma?
  3. -Palpate medial canthus for mobility (worried about sinuses)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PE- ears

A
  1. Drainage (blood, CSF?)
  2. Ear lac?
  3. Auricular hematoma, Battle sign (ecchymosis behind the ear – basal skull fx)
  4. TM’s - hemoptypanum, rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what do you need to palpate in facial trauma

how to assess for mandible fracture

how to check maxillary arch

A

Palpate entire face, both hands
Look for tenderness, bony crepitus, subcutaneous air, flattening, anesthesia
Palpate entire orbital rim

check if anterior maxillary arch is stable - if it moves at all, stop
• Intraoral palpation of zygomatic arch

• Tongue blade test for mandible Fx- bite down, twist
If can hold on, likely no Fx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

systems you should not forget in ENT assessment

A
  1. Scalp, Neck, Neuro exam, CN exam, Chest wall, lungs, heart, abdomen, extremities, pelvis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what should be done

what needs to be administered
what should you avoid

What imaging do you need for the mandible

A
  1. ABC’s first - suction
  2. Consider IV - pain control, Abx; TETANUS
  3. Pain control
    a. IM/IV or topical (eyes, nose) - AVOId po’s
  4. Imaging - CT preferred over plain film
    a. Panorex for mandible

before you call a surgeon have a dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MOA of frontal sinus fx

A

right above the eyebrows you will have penetration into the brain

  1. Significant mechanism-MVA
    a. Common prior to seat belts

may have forhead lacs
high risk for intracranial injury and bleeding in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

sxs with frontal sinus fx

A

Bony crepitus, deformity, subcutaneous air, limited upward gaze, ptosis, sensory deficit forehead

need to het the bony windows in a CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

frontal bone injury is common in what do we worry about in these populations

A

children

much higher incidence of intracranial truama

Higher incidence of intracrainial trauma with frontal bone Fx - consider CT head

Frontal bone trauma – worry about the kid’s neck

Upper cervical spine injury more common than lower in kids

worry about to abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nasoethmoidal-orbital fractures occurs form trauma to this

associated with these type of injuries

A

Small NEO Fx’s easy to miss
Trauma to bridge, medial orbits

Associated with lacrimal injury and dural tears (encephalities or brain infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

sxs asscoaited with nasoethmoidal-orbital fractures

A
  1. Pain at medial bridge, w/ EOM’s

5. Maybe crepitus, telecanthus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

mnmgnt of Nasoethmoidal-orbital fractures

A

(if eyes are further apart than they should be)

6. CT, Abx, OMFS, admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Orbital Floor – Blow out fx

what do you need to document

A

you can have this without entrapment but if you have entrapment of this muscle it needs to be repaired
this is when the muscle of the eye does not work

you say look up and one moves and the otherone does not (tethered and stuck)

IS THERE DBL vision on upward gaze*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Orbital Floor – Blow out fx how many have globe rupture

A

c. 30% have globe rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

mngmt of orbital floor fx PE and imaging

A

CT maxillo-facial and orbits (head? If LOC)

Check eye: vision, hyphema, pressures, subconjunctival hemorrhage, subcutaneous emphysema (air b/c maxillary sinus has ruptured and the air escapes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

who do you call and what do you do for orbital floor fx

A

c. Check infraorbital anesthesia
d. OMFS, ophtho (since there is entrapment) consult
e. Pain control, tetanus; admit?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

telecanthus means

A

if eyes are further apart than they should be)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lateral canthomotomy -when would this be indicated and what is it

A

Orbital Compartment Syndrome

need to cut the lateral canthus to allow more room for the globe

this can be a site saving procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

RF with retrobulbar hematoma

A

vision loss, pupil irregular, papilledema, IOP up, field deficit = optic neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

limbus in retrobulbar hematoma

A

Limbus – where the conjunctiva ends (around the pupil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what does periorbital, Orbital Cellulitis entail

A
  1. Unilateral infection around or around and behind orbital structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

sxs of periorbital, Orbital Cellulitis

A
  1. Fever, red, swelling
  2. EOM’s painful
  3. Proptosis if orbital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

tx of orbital and periorbital

A

Periorbital:
a. Abx, +/- admit

Orbital Cellulitis-vision and life threatening need to admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

imaging for periorbital cellulitis

A

CT orbits all, ULS useful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

questions you want to ask with nasal fx

A

Prior nasal trauma, deformity?

  1. -Can you breathe thru your nose?
  2. -Blow nose = face swelling?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

nasal fx secret

What do you NEED in your chart

A

Check for nasal-septal hematoma**
a. -If present, must I&D or necrosis of septum ensues

if you see this it is a ENT emergency that needs to be drained or else you will have necrosis of the septum

LOOK UP IN THERE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

ENT f/u with nasal trauma

A
  • “Reduction”- specific cases only

8. -ENT f/u 5-7 days after edema subsides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

imaging for nasal fx

A

X-rays- “bucket handle” view - depression?

CT common: other fx’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

tripod fxs involve ….

A
  1. Involve the maxilla, the orbit, and the zygomatic arch

significant mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

suspected maxillary fx with swelling indicated imaging

A
  1. CT for Dx, OMFS consult, Ophtho consult, admit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

maxillary fxs are

A

Common; if isolated =less serious

  1. Direct blow, swelling
  2. Periorbital edema, subconj hemorrhage, flat cheek bone
  3. Intraoral exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what do we see associated with a tripod fx

A

Lateral subconjunctival hematoma

Infraorbital anesthesia

Check eye, lateral canthus pulled downward

often seen with Trismus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

High-energy, midface, not subtle

A

LeFort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

mnmgt and workup of LeFort

A

Fracture patterns often mixed

b. Check hard palate/upper teeth mobility
c. CT, Abx, tetanus
d. OMFS and Optho consult
e. Admit for open reduction and fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

LeFort classifications

A

I- mustach
II-nose involvement
III-eyes down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

big thing you need to assess this on mandible fx

A

Open or closed?

look at the cortex

open- gingival lacs with tooth disruption

OPEN-extends through the alveolar ridge gumline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

sxs with mandible fx

A

Tender, swelling, trismus, malocclusion, jaw ecchymosis, bite test

unusual to fx in one spot

look for multiple

OPEN= blood in mouth, gingival lacs, teeth loose separated or uneven

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

pathognomonic signs for open fx

A

Sublingual hematoma is pathognomonic

and bruising beneath the jaw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

tx for mandible fx

open

A

Open - OMFS, Abx, tetanus, admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

tx for mandible fx closed-

A

Closed - outpatient f/u

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

post trauma, seizure or spontaneous with jaw open suspect

A

TMJ Dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

TMJ dislocation can be

A

Can be bilateral or unilateral – taking a big bite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

tx and reduction of the jaw

A

X-rays if traumatic
-Pain meds, anxiolytics, suction

Downward pressure on the jaw, rock and pull forward - from above or from front of patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

post reduction management of jaw dislocation

A

-Liquid diet for 3 days, OMFS f/u

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

differentiating unilateral from bilateral TMJ dislo

A

jaw away from side of dislocation. Bilateral - protrudes forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Hearing Loss initial management

A
  • Sudden or gradual?
  • Partial or total?
  • Unilateral or bilateral
  • Associated Sx’s: tinnitus, vertigo, HA, drainage, pain
  • Conductive or Sensorineural?
  • Look in ear first, then look for the tuning fork
  • Weber test - tuning fork on head
  • Rinne test - mastoid then next to ear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what are important questions you want to be asking with hearing loss

A

(usually intracranial issue)?

Trauma, recent infection, meds (bilateral)

NSAIDS,
aminoglycosides,
erythromycin,
Lasix, ASA, antimalarials, chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

evaluation of sensorineural vs conductive

A

Conductive - BC>AC

Sensorineural loss - AC>BC or can’t hear it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

describtion of Cerumen Impaction

A
  1. Well appearing pt
  2. Fullness, “underwater”
  3. Have to document that the TM look good after removal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

mangement of conductive cerumen impaction

A

a. Manual – curette
b. Irrigate:
i. 18g angiocath w/o needle
ii. 1part peroxide, 2parts water
iii. Irrigate w/ 30cc syringe
iv. Immediate relief sx’s

54
Q

Malignant Otitis Externa

A
  1. Elderly, DM, immunocomp

3. Unresponsive OE, Pseudomonas

55
Q

presentation of OME

A
  1. Painful, especially with movement of tragus
  2. Conductive hearing loss +/-
  3. Thick, granulation tissue in canal, +/- can’t see TM, facial nerve palsy or paralysis
56
Q

tx of OME

A

Admit, IV anti-pseudomonals, ENT consult

57
Q

appearance and management of fungal OE

A

Chronic OE in DM, immunocompromised

Painful, white or black fuzzy discharge in canal

Suction out canal, antifungal/acetic acid

58
Q

Perichondritis presentation

A

Auricle/pinna is infected

Acute, supprative

Auricle tender, warm, swollen - TM normal

Check behind the ear! Think mastoiditis

59
Q

Perichondritis tx

A

IV Abx (pseudomonas),

ENT

consider admit

60
Q

Herpes zoster of face with involvement of auricle and TM

A

ramsey hunt

61
Q

Ramsay Hunt Syndrome sxs need to check for

A

Painful, unilateral

Hearing loss, peripheral facial paralysis or sensory loss

Acyclovir, steroids, pain meds

Check for corneal involvement –

Hutchenson’s sign (zoster lesions on tip of the nose)

62
Q

Herpes Zoster Oticus

A

48hr f/u after ENT consult

Just auricle (NOT the TM)= Herpes

Zoster Oticus

63
Q

Painful, ear canal abscess

A

Furuncle

64
Q

furuncle in the ear mngmt

A

Exquisitely tender

Hair gets infected and you get a zit in your ear canal

Tragal motion tender

Staph Aureus
d. Needle aspirate or I&D

Abx, pain meds
65
Q

mngmt of FB

A

Insect: lidocaine drops - mosquito forceps

Kids: may need sedation

Irrigate if not organic

Check TM

Tx for otitis externa

66
Q

OM sxs and tx

A

Red, bulging TM, decreased mobility

Amoxicillin still first-line

  1. Serous otitis media
    a. “Fullness”, bubbles, TM not red
    b. Decongestants
67
Q

Painful, clear or red blisters on TM suspect

A

Painful, clear or red blisters on TM

URI common

68
Q

Bullous myringitis tx

A

Mycoplasma or viral - Tx with macrolides (erythromycin or azithromycin)

69
Q

painful hearing loss and tinnitius suspect

A

TM Perforation

Post-infection, blunt or penetrating trauma, noise trauma, barotrauma

Painful, hearing loss

Blood, serous fluid or no discharge
Tinnitus, vertigo common
Up to 90% heal on own

70
Q

TM Perforation will see webber will lateralize to

A

Weber lateralizes to affected side

71
Q

TM Perforation tx

A

Ear dry, no drops, suspension ok

Refer to audiology, ENT

72
Q

Cholesteatoma what is it exactly

A

Squamous epithelium mass behind TM

Acquired or congenital
3. Grows, erodes TM, ossicles

73
Q

why do we care about Cholesteatoma

A

Grows, erodes TM, ossicles

will lose hearing

74
Q

big red flag with Cholesteatoma

A

neuro symptoms

75
Q

mngmt of Cholesteatoma

A

CT if suspect, then MRI

ENT for removal
76
Q

Auricular Hematoma we are worried about

A

Leads to necrosis if no tx: “cauliflower ear

77
Q

tx of auricular hematoma

A

Incise edge, evacuate clot

+/- suture – check with ENT consultant

Dressing packed firmly into contours/behind ear

Pressure dressing

24hr follow-up - check clot recurrence

78
Q

ear lac mngmgt

A
  1. Block the ear or local anesthesia

Suture through skin, not cartilage, to close
Non-absorbable

  1. 6-0 suture best
  2. Attempt to retain shape, contour
  3. Do not debride too aggressively
79
Q

Mastoiditis mngmt and sxs

A

Rare, serious, toxic pt

. Complication of unresolved OM

Can be chronic

Hearing loss, ear pain, tender fluctuant mastoid, TM red, +/- perf with discharge

CT head w/o con 

IV Abx, ENT consult

Kids, toxic = admit
80
Q

Nasal Furunculosis/Cellulitis mngmt

A

Infected hair follicle - usually Staph, cover MRSA

  1. Remove offending hair
81
Q

TX OF nasal Furunculosis/Cellulitis mngmt

A

Abscess of cartilage, ala, columella cellulitis

know this anatomy!

DM, immunocomp - admit

82
Q

Nasal Foreign Bodies tx

A

Infants, little kids: parent occludes opposite nostril and blows into mouth

vasoconstrict with Neo-synephrine or Afrin mixed with lidocaine (not w/ Cocaine)

Blow after vasoconstriction

Alligator forceps, ear curette, Dermabond on end of q-tip or small foley cath passed beyond object – inflate – pull out

no luck–> call ENT

83
Q

Organic FB

A

Organic FB? Irrigate gently - say “eng”

eeeengg

84
Q

BIG epistaxis mangement

A

nterior (90%) or posterior (serious bleed)?

85
Q

90% of nosebleeds occur here

A

Coumadin? Trauma?

-90% at Kiesselbach’s plexus (anterior bleed)

86
Q

anterior bleed

A

Blow nose gently–> - get clots out

b. -Sit forward/pinch

87
Q

if it won’t stop bleeding

A

Gown, glasses, light, suction

Soak several Q-tips in 4% Cocaine or Neo-Synephrine w/ 4% Lido

-Apply to nostril

Tranexamic acid topical - new

88
Q

Silver Nitrate cautery stick mngmt

A
  • Silver Nitrate cautery stick
    a. -Minimum, one side only
    b. Don’t cauterize the septum

-Abx ointment over site, saline nasal spray

89
Q

inserting a nasal tampon

A

Tampon packing (start with tampon, then rhino rocket if that doesn’t work)

straight and down

Insert along floor of nasal cavity – lube w/ abx oint

Moisten after insertion - expands to space

24hr f/u, Abx, saline drops

90
Q

alternative to nasal tampon

A

Rhino Rocket - tampon alternative

i. Mesh covered, inflate w/ saline
c. Still bleeding? Nasal balloon + ENT

91
Q

management of sinusitis

A
  1. Unilateral, face pain, purulent d/c, teeth pain, HA; Sx’s +/- 7days
  2. Vast majority viral - Abx if fever, hx chronic
  3. Decongestants
  4. Not imaged in ED*
    a. CT preferred
    b. Plain xrays if no CT
92
Q

dental fx described by

A

Describe what is exposed

a. Enamel only
b. No further Tx
c. Dental referral
d. Ellis I, Class I, etc

93
Q

what is a ELLIS II

A

See yellow dentin exposed

b. Cover with cement
c. Dental consult
d. 24hr f/u
e. Ellis II, Class 2, e

94
Q

Ellis III management

A

Dental consult now

b. Cover with cement or isolate tooth with moist, sterile gauze
c. 24hr f/u - discuss necrosis, tooth loss

95
Q

Concussion what is the mngmt

A

painful but not loose, no ED Tx, dental f/u

96
Q

Subluxation what is it and what is the mngmt

A

loose

a. Push very loose back in - stabilize/splint
b. PCN VK, dental f/u 24hrs

97
Q

tooth avulsion

A

totally out

<15min – gently clean tooth, socket - push back in

15min - 2hrs - soak tooth in milk, clean socket, replace

c. >2hrs - same with discussion
d. PCN VK, dental f/u 24hrs
e. No tooth? Get a CXR

98
Q

Alveolar Ridge Fracture need to

A

Subluxed or avulsed teeth

–>Lift lip, check buccal space. Hematoma

99
Q

Alveolar Ridge Fracture signs and tx

A

Ridge moves with palpation

Panorex; then/or CT 

IV Abx, pain control

OMFS consult
100
Q

Dental Abscess or Infection mngmt

A

Facial edema, pain, tender tooth

Block tooth locally if possible (bupivicaine)

I&D in ED only if clearly pointing or buccal space is full, fluctuant

Dental referral 24hrs
101
Q

RF in dental pain

A

If fever, trismus, big swelling, face redness:

OMFS now

102
Q

rx for dental abscess

A

PCN/Amox/ Clindamycin pain meds, warm rinses

Definitive tx is pulling the tooth
103
Q

dry socket mangmenet

A

Block the tooth, irrigate socket with warm NS

Gently pack socket with ¼” plain packing gauze soaked in clove oil or dry socket paste

Dentist 24hrs

104
Q

Painful necrosis socket, 2-4 days post extraction

A

dry socket

105
Q

Necrotizing Ulcerative Gingivitis (Trench Mouth)

what does this look like

A

Fetid breath (can’t even get near them, it’s smells horrible), bleeding gums, fever, pain, immunocomp

Punched out” interdental papilla

106
Q

rx of trench mouth

A

Flagyl, Chlorhexidine rinse, dental and PMD f/u for w/u

107
Q

most important consideration with lip lac

A

Cross vermillion?

Margin of error is 2mm at MAX!!

a. Approximate first
b. First suture must line up

108
Q

mangemetnt of lip laceration

A

Irrigate, sew outer part first

Irrigate again, and then sew mucosa

109
Q

anesthesia an stitches of lip lac

A

Anesthesia: regional block
Infra-orbital nerve (upper) – fantastic

Mental nerve (lower)

  1. Absorbable 4-0 for mucosa
  2. Non-absorbable 6-0 for lip and skin
110
Q

Oral mucosal lacs: repair

A
  1. Oral mucosal lacs: repair only large or flapping – rest will heal
111
Q

mnmgnt for tongue Lacerations (your own teeth get your tongue)

A
  1. Small, mid-tongue: control bleed, ice, may not need sutures
  2. Thru/thru, at edge, w/ flap, large lac: suture
112
Q

anesthesia and sutures for tongue lac

A

a. Use lidocaine/bupivicaine w/ epi
b. Lingual nerve block for anterior 2/3 tongue – lingual side 2nd lower molar
c. Local as alternative: painful

  1. Absorbable 4-0 suture (can use non-absorbable); bury knot
  2. Complex – consider layered closure
113
Q

Sialolithiasis MC

A

Sialolithiasis = Salivary gland stones – obstruction

Most Common: Wharton’s duct

Wharton’s duct is the submandibular duct – floor of the mouth

114
Q

concerns with Sialolithiasis

tx

A

Sudden edema, pain; possible infection
a. Mouth pain and tongue pain

Abx, lemon drops, analgesia, ENT f/u

115
Q

Sialoadenitis

A

Mumps

Viral prodrome, mostly involves parotid gland

i. Stenson’s duct is the parotid duct – next to upper 2nd molar
b. Non-immunized kids/adults

116
Q

Bilateral cellulitis of submandibular space

A

x. Ludwig’s Angina

117
Q

Ludwig’s Angina MC origin

A

Odontogenic origin common (lower tooth usually in the front with a big abscess)

Fever; painful, tense, red edema under chin; trismus, dysphagia, dysphonia

tongue displaced upward, edema of floor of mouth, edema of submental space

118
Q

big concern and mangement of ludwigs

A
  1. Rapid progression, polymicrobial
  2. Airway the big concern
  3. CT is test of choice, IV Abx
  4. ENT, admit, airway precautions
119
Q

Uvulitis presentation

A
  1. Sore throat, FB sensation
  2. Uvula is big, red, angry looking; may touch tongue and cause gag
    Position is midline tho if it is JUST the uvula
  3. Think allergy, angioedema first
120
Q

ts of uvulitis

A

Abx for strep, consider steroids

Pain meds, slippery foods, close f/u
121
Q

pharyngitis centor score

A

NO COUGH

EXUDATE

TENDER LYMPH NODES

SORE THROAT

if you have 4 treat 3?

122
Q

uvula not midline suspect

A

Peritonsilar Abscess

cellulitis vs abscess

Sore throat, “hot potato” voice, trismus, fever

  1. Unilat peritonsilar & soft palate redness, fluctuance
  2. Uvula is NOT midline
  3. Uvular deviation away from abscess
123
Q

Peritonsilar Abscess mangment

A

18g needle, 3 puncture sites
Beware “big red”

ULS the swelling for fluid with transvaginal probe
7. Topical anesthesia then inject w/ lido w/ epi

Abx, pain meds, 24hr f/u (abscess can recur)

if you have a dry tap treat for cellulitis

124
Q

tx for cellulitis of uvula

A

Dry tap? Tx for cellulitis (Clindamycin)

125
Q
  1. Neck pain (pain when look up), dysphagia, fever

pain and sx’s out of proportion to exam

A

xiii. Retropharyngeal Abscess

1. Kids and adults

126
Q

Retropharyngeal Abscess imaging

A

CT neck is best, diagnostic

  1. Airway concerns
  2. ENT, IV Abx, admit
127
Q

worse sore throat of my whole life
fever
haven’t eaten and doesn’t look like a sore throat

A

RPA or epiglottitis (not immunized)

128
Q

immunization that has really diminished epiglottitis

A

H.flu vaccine

129
Q

common sxs of epiglottis

A

Rapid onset, sore throat, fever

Drooling, voice changes, positioning

130
Q

imaging for epiglottitis

A

Soft tissue neck - portable if worried

  1. If has it – IV, monitor, airway equipment
  2. Abx, steroids, ENT, admit
131
Q

FB sensation at rest, worse with swallowing

A

Laryngoscope, fiber optic scope, mirror

Soft tissue neck, CXR

  1. Often abrasion only (it isn’t itself there)
  2. Pulmonary or GI consult
    a. Go fishing

Emergency Medicine (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions