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Emergency Medicine > ENT and Dental Emergencies > Flashcards

ENT and Dental Emergencies Flashcards

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1
Q

what organisms commonly cause otitis media?

A

S. pneumonia, H. influenza, M. catarrhalis

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2
Q

Treatments for Otitis Media (5)

A 
Amoxicillin 
Augmentin 
Cefdinir 
Cefpodoxime 
Levofloxacin
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3
Q

Complications with Otitis Media

A

mastoiditis, cholesteatoma, intracranial extension [meningitis/abscess], lateral sinus thrombosis, facial nerve paralysis/paresis

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4
Q

Common bacterial organisms for Otitis Externa

A

P. aeruginosa [MC]

S. aureus, Enterobacteriaceae, proteus

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5
Q

Common fungal organisms for Otitis Externa

A

aspergillus

candida

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6
Q

Antibiotic treatment for otitis externa

A 
ofloxacin
Cipro/Dex
Acetic Acid 
neo/poly
hydrocortisone
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7
Q

when does otitis externa become life threatening?

A

spreads to involve pinna, surrounding soft tissue and possibly skull base [all the deeper tissue]

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8
Q

What is the predominant organism in malignant otitis externa? What are they seeing more case though of?

A

P. aeruginosa

MRSA

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9
Q

what could the organism be in malignant otitis externa if the patient is immunocompromised or diabetic?

A

fungal

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10
Q

which symptom is a bad indicator for malignant otitis externa?

A

trismus

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11
Q

treatment for malignant otitis externa in children?

A

imipenem

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12
Q

treatment for malignant otitis externa in adults?

A

antipseudomonal PCN (pipercillin-tazobactam)
aminoglycoside (tobramycin, gentamicin)
quinolone (Cipro)

cephalosporin (ceftazidime, cefepime)

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13
Q

treatment for funal malignant otitis externa

A

voriconazole

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14
Q

blood accumulates in the sub-perichondrial space of the ear → tender and fluctuant mass

A

auricular hematoma

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15
Q

treatent for auricular hematoma

A

anesthesia (1% lidocaine without epi) →small eliptical incision with #15 blade → express → irrigate → compression dressing
Can also aspirate with 18G needle

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16
Q

If you prescribe an antibiotic for auricular hematoma, what would you give?

A

cephalexin
quinolone
amoxicillin + clavulanic acid (Augmentin)

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17
Q

what specific spot in the ear do you worry with TM ruptures?

A

posterosuperior quadrant perforations

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18
Q

4 potential spaces for masticator infections

A

masseteric/submasseteric
superficial temporal
deep temporal
pterygo-mandibular space

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19
Q

types of organisms seen in masticator space infections

A

anerobic and aerobic oral streptococcal
Peptostreptococcus, bacteroides, prevotella, porphyromonas, fusobacterium, actinomyes, veillonella, anaerobic spirochetes

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20
Q

prefered diagnostic test for masticator space infections

A

CT face with contrast

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21
Q

preferred antibiotic for masticator space infection & two others

A

Clindamycin (preferred)

[ampicillin-sulbactam, penicillin + flagyl]

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22
Q

masticator space infections have a risk of progressing to

A

mediastinitis

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23
Q

most common location for mandibular dislocation

A

anteriorly

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24
Q

what should you check in patient with posterior mandibular dislocation?

A

ears → dislocate posterior can disrupt the auditory canal and create “open dislocation”

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25
Q

what medication should a patient get for mandibular dislocation?

A

pain relief

muscle relaxant → benzodiazapene

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26
Q

if patient presents with mandibular dislocation secondary to a medication (neuroleptic or antipsychotic) or realted to dystonic reaction, how do you treat?

A

diphenhyramine

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27
Q

anterior nose bleeds come from →

posterior nose bleeds come from →

A

Kiesselback plexus

sphenopalatine artery

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28
Q

How to approach a patient with epistaxis, first thing to do?

A

determine bleed location
posterior MC in elderly, those with inherited coagulopathy, significant posterior pharynx blood, hemorrhaging from both nares

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29
Q

what labs may you want to order for epistaxis?

A

CBC, Type & Cross, Coagulation studies

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30
Q

what should you do if your patient is hemodynamically compromised and has epistaxis?

A

IV bloodwork, transfusion, reverse coagulopathy, manage BP, may need surgery

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31
Q

First step in treating epistaxis

A

direct nasal pressure → blow nose, give Afrin, “sniffing position”, pinch soft nares for 15 min or give nose clamps

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32
Q

How many times you should try step 1 for treating epistaxis before it is considered a failure?

A

twice → 15 minutes each

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33
Q

second step in treating epistaxis

A

chemical cautery (silver nitrate swabs) →anesthetize nasal mucosa with topical 1:1 0.05% oxymetazoline & 4% lidocaine solution (may have 1-2% epi) → apply to bleeding site for 1-3 second and ONE SIDE OF SEPTUM ONLY

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34
Q

third step in treating epistaxis

A 
thrombogenic foams and gels 
gelfoam or surgicel (bioabsorbable and don’t need removal)
floseal (hemostatic gelatin matrix with thrombin) 
tranexamic acid (new stuff)
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35
Q

fourth step in treating epistaxis

A

Anterior packing

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36
Q

what is used in anterior nose packing?

A

rapid rhino → anterior balloon inserted straight back in the nose and inflated with 5-10 cc of AIR

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37
Q

fifth step in treating epistaxis

A

posterior packing and ENT consult

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38
Q

complications associated with epistaxis

A

pressure necrosis
infection
hypoxia
cardiac dysrhythmias

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39
Q

when can you discharge a patient with epistaxis?

A

bleeding is controlled + hemodynamically stable + observation > 1 hour

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40
Q

Discharge instructions for epistaxis

A 
ENT visit in 1-2 days 
give Afrin and instructions on use 
INR monitoring if on Warfarin 
No NSAIDs for 72 hours 
antibiotic if packing > 48 hours → Augmentin
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41
Q

True or False, we can reduce nasal fractures in the ER

A

false → refer to ENT

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42
Q

common complication of nasal fractures

A

septal hematoma → hematoma lifts the perichondrium and disrupts blood flow to the septum

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43
Q

what is one thing you need to document for in the note for patient with nasal fracture?

A

if septal hematoma is present or not

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44
Q

Patient has dental fracture - what is the goal of management?

A

preserve pulpal vitality

45
Q

what type of dental fracture requires intervention?

A

enamel-dentin fracture (70% of tooth fractures) → look for yellow/creamy colored exposure

46
Q

If your patient can’t see a dentist within 24 hours for an enamel dentin fracture, what should you do?

A

cover exposed dentin with DenTemp or calcium hydroxide (Dycal)

47
Q

What tooth fracture presents with tooth bleeding?

A

enamel-dentin-pulp fracture

48
Q

which tooth fracture will usually need pain control?

A

enamel-dentin-pulp fracture

49
Q

6 types of tooth luxations

A 
concussion 
subluxation 
extrusive luxation 
lateral luxation 
intrusive luxation 
avulsion
50
Q

tenderness and no tooth mobility

A

concussion

51
Q

tooth mobility without dislodgement

A

subluxation

52
Q

partial tooth dislodgement

A

extrusive luxation

53
Q

tooth displacement towards lip or tongue with alveolar fracture

A

lateral luxation

54
Q

tooth displacement into the socket with liagment damage

A

intrusive luxation

55
Q

tooth displacement from the socket

A

avulsion

56
Q

treatment for tooth concussion

A

NSAID and dentist consult

57
Q

treatment for tooth subluxation

A

warn that they are at higher risk for necrosis, see dentist

no splinting

58
Q

treatment for extrusive luxation

A

reposition and stabilize → may need local anesthesia
splint with zinc oxide periodontal dressing (Coe-Pak)
see dentist within 24 hours

59
Q

treatment for lateral tooth luxation

A

temporary splint with relatively stable → dentist consult ASAP

60
Q

treatment for intrusive tooth luxation

A

soft diet + meticulous oral hygeine + chlorohexidine rinse BID
will likely self erupt or be extracted by dentist

61
Q

treatment for tooth avulsion

A

replantation ASAP @ scene of injury

62
Q

Antibiotic for tooth avulsion

A

Doxycycline for adults

amoxicillin if < 12 years

63
Q

If tooth has been dry for > 60 minutes why should you try to replace it?

A

preserve alevolar bone contour and aesthetics → tooth loss is expected

64
Q

Approach for managing luxation of primary

A

never replant avulsed primary teeth

65
Q

1 cause of pharyngitits/tonsillitis

A

viral → rhinovirus

66
Q

guidance for who to test and treat for strep pharyngitis

A

CENTOR criteria

67
Q

CENTOR criteria includes

A

age (3-14 years)
tonsillar swelling or exudates
swollen and tender anterior cervical lymph nodes
+/- cough (+ cough more associated with bacterial)
temperature (>100.4)

68
Q

what is responsible for the 5-15% cases of pharyngitis in adults?

A

GABHS → streptococcus pyogenes

69
Q

Common presentation of Streptococcus pharyngitis in adults

A

sore throat, painful swallowing, chills, fever
tonsillar/pharyngeal edeam (62%)
tonsillar exudates (32%)
enalrged cervical lymph nodes (76%)
may have cough (25%) but less likely to have rhinorrhea

70
Q

why do you give antibiotics for GABHS?

What does it not prevent?

A

prevent complications and rheumatic fever

glomerulonephritis

71
Q

first line treatment for GABHS?

A

PenVK PO
Amoxicillin PO
benzathine PCN 1.2 million units IM

72
Q

If your patient has GABHS infection and PCN allergy then they get?

A

1st generation cephalosporin (cefazolin, cephalexin)

clindamycin

73
Q

what can be given to manage pain associatedwith GABHS?

A

PO or IM dexamethasone

74
Q

what can uvula edema present with?

A

GABHS, peritonsillar abscess, epiglotitis

75
Q

Treatment for isolated uvular edema that is uncomfortable

A

dexamethasone (single dose)

76
Q

collection of purulent material between tonsillar capsule, superior constrictor, and palatopharyngeal muscles → can be complication from strep or occur on its own

A

peritonsillar abscess

77
Q

microorganism common with peritonsillar abscesses

A

polymicrobial → MC Fusobacterium necrophorum

78
Q

major physical exam finding for peritonsillar abscess

A

contralateral displacement of swollen uvula

79
Q

treatment for peritonsillar abscess

A

needle aspiration, I&D, surgical tonsillectomy (rare)

80
Q

treatment for peritonsillar abscess

A

(against GABHS & anaerobes → F. necro)
Pen VK + metronidazole
clindamycin
piperacillin-tazobactam IV (if toxic or PO intolerant)
for pain → methylprednisolone or dexamethasone

81
Q

how to perform needle aspiration for peritonsillar abscess?

A

lidocaine or benzocaine-tetracaine topical spray to mucosa → inject lidocaine + Epi with 25G needle → 18G neede lateral to tonsil NO MORE THAN 1 CM DEEP → pus is seen if encounter cavity

82
Q

Triad for epiglottitis

A

Drooling, Dysphagia, Distress [3 D’s]

83
Q

how to confirm diagnosis of epiglottitis

A

lateral soft tissue x-ray or transnasal fiber laryngoscopy

84
Q

immediate treatment options for epiglottitis

A

intubate awake

awake tracheostomy or cricothyrotomy

85
Q

pharmacological treatment for epiglottitis

A

methylprednisolone

cefotaxime + vancomycin

86
Q

space anterior to prevertebral fascia that extends from the base of the skull to tracheal bifurcation

A

retropharyngeal space

87
Q

organism MC seen with retropharyngeal abscess

A

polymicrobial → GABS, MSSA, MRSA, H. flui, bacteroides, peptostreptococcus , fusobacterium

88
Q

test of choice if you suspect retropharyngeal abscess

A

CT neck with contrast

89
Q

How do you differentiate retrophayngeal abscess from epiglottitis?

A

lack thumbprint sign and will have very swollen prevertebral muscle

90
Q

treatment for retropharyngeal abscess

A

clindamycin or Cefotitin

piperacillin-tazobactam or ampicillin-sulbactam

91
Q

MC cause of odontogenic abscess

A

polymicrobial → strep viridans, peptostreptococcus, prevotella, staphylococci

92
Q

Ludwing’s Angina is infection of what 3 spaces

A

submental space
sublingual space
submandibular space

93
Q

Patient with Ludwig’s Angina has necrotizing fascitits, how do you manage it?

A

IMMEDIATE surgery → fasciotomy, debridement, IV antibiotics

94
Q

Bones that make up the 4 walls of the orbit

A

superior → frontal bone
lateral → zygoma + sphenoid
medial → ethmoid
inferior → zygoma + maxilla

95
Q

second most common fractured facial bone

A

mandible (1st is nasal)

96
Q

6 regions of the mandible

A 
body (21%)
angle (36%)
ramus 
parasymphyseal (17%)
coronoid
condyle
97
Q

on exam the hard palate and upper teeth move

A

Le Fort I Fracture

98
Q

on exam, movement of nose, teeth, and hard palate

A

Le Fort II Fracture

99
Q

Patient with Le FortII fracture may have sensory deficit where?

A

below the eyelids and numbness and tingling of the face → infraorbital nerve canal

100
Q

where are Le Fort III fractures?

A

extend through frontozygomatic suture lines → across orbit and through the base of the nose and ethmoid region

101
Q

What commonly occurs with Le Fort III fractures?

A

airway compromise (edema and hematoma)

102
Q

MC site for orbital blowout fractures

A

maxilla

103
Q

patient has diplopia on upward gaze

A

trapped inferior rectus m

104
Q

Patient has blowout fracture and anesthesia

A

possible infraorbital nerve entrapment

105
Q

Most concerning finding that is suggestive of inferior orbital displacement through the orbital floor

A

enophthalmous

106
Q

study of choice if your patient has blowout fracture

A

CT of face

107
Q

what should patient with blowout fracture avoid?

A

valsalva, bending over, nose blowing

108
Q

You can discharge a patient with blowout fracture and tell them to follow up with maxillofacial surgeon or ENT if…

A

there is no muscle entrapment or enophthalmos

Emergency Medicine (6 decks)

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