ENT Emergencies Flashcards
Define a hematoma auricle.
Collection of blood within the cartilaginous auricle.
Define a hematoma auricle laceration.
Damage to the perichondrium (connective tissue that envelopes cartilage).
Define chondritis.
Infection of the cartilage of the ear.
State bacteria that could cause the hematoma infection.
1) S. aureus 2) Pseudomonas aeruginosa
Define otitis externa.
Inflammation of the ear canal.
State bacteria that could cause otitis externa.
1) Pseudomonas 2) Staphylococcus aureus.
State a treatment of otitis externa.
1) Antibiotic (ciproflacin) - steroid (dexamethasone) drops 2) Use wicks to drain tight canals
State 2 symptoms of otitis externa.
Swelling. Redness. Heat. Discharge of pus.
What is the treatment for foreign bodies in the ear canal?
1) Lidocaine (anaesthetic to block pain)
What is a tympanic membrane perforation?
Hole in thin tissue separating ear canal from the eardrum. (Treate with antbiotics)
State the cause of a tympanic membrane perforation.
Middle ear pressure secondary to fluid or barotrauma (ear damage).
Define otitis media (middle ear).
Inflammation and build up of fluid behind the ear drum.
State a symptom of tympanic membrane perforation.
Vertigo (spinning sensation). Ear pain. Hearing loss. Tinnitus (ringing in ear).
State a cause of otitis media (middle ear).
1) Commonly in children 3-6 years old 2) May follow an upper respiratory tract infection (e.g. Strep pneumoniae, H infuenzae)
State 2 symptoms of otitis media.
Earache. Hearing loss. Fever. Deafness. Irritability. Lethargy.
State a complication of otitis media.
1) Drum perforation 2) Secondary mastoiditis
State a treatment of otitis media.
1) Analgesia 2) Antibiotics 3) Consider AB if no improvement within 72 hrs or earlier if worsening or perforation
Define peripheral vertigo (vestibulopathy).
It’s a problem with the inner ear which controls balance, resulting in a mild-moderate spinning sensation.
State the 4 types of vertigo.
1) Benign paroxysmal positional vertigo (BPPV) 2) Labyrinthitis 3) Vestibular neuronitis 4) Meniere’s disease
Define Benign paroxysmal positional vertigo (BPPV).
Small pieces of debris break off in the inner ear, to stimulate small hairs.
State how Benign paroxysmal positional vertigo (BPPV) is diagnosed.
Hallpike manoeuvre results in Fatiguable nystagmus.
State how you clear the debris in Benign paroxysmal positional vertigo (BPPV).
Epley manoeuvre.
Define labyrinthitis.
It’s a viral infection of the inner ear, resulting in damage to vestibular-end organs responsible for hearing.
Define vestibular neuronitis.
Infection that has spread to the vestibular nerve (controls balance).
State a symptom of labyrinthitis.
Severe vertigo. Nausea. Vomiting. No deafness/tinnitus.
Define vestibular neuronitis.
Disorder characterised by a sudden onset - infection spread to the vestibular nerve (controls balance).
State 2 symptoms of vestibular neuronitis.
Unsteadiness. Earache. Nausea. Vomiting.
Define meniere’s disease.
Increased pressure in the endolymphatic system of the inner ear causes recurrent attacks of vertigo.
State 2 symptoms of meniere’s disease.
Nausea. Vomiting. Hearing loss. Fullness in ears.
State a treatment of inner ears.
Antihistamine. Prochlorperazine (anti-psychotic medicine). Fluids. Rest.
Define central vertigo.
Refers to problems with your brain/brainstem rather than your ear.
Define mastoiditis.
Bacterial infection of mastoid cells in mastoid bone (located behind the ear).
State 2 symptoms of acute mastoiditis.
Pain. Swelling. Tenderness.
State the treatment for milf Epistaxis.
1) ABC 2) Trotter’s method (make patient sit up, pinch the nose for 5-10 minutes, head bent forward, open mouth and breathe) 3) Ice packs behind neck
State the 2 types of Epistaxis.
1) Anterior - 90% Kisselbach’s plexus (usually in children/young adults) 2) Posterior - 10% (usually in elderly).
State a cause of anterior Epistaxis.
Trauma. Winter syndrome. Irritants-cocaine. Pregnancy.
State a cause of posterior Epistaxis.
Coagulopathy. Atherosclerosis. Neoplasm (abnormal mass of tissue that forms when cells grow and divide). Hypertension (debatable).
State how anterior epistaxis is managed.
Using rapid rhino (high volume low pressure tamponade to ensure gentle compression). These packs require antibiotic prophylaxis.
State how anterior epistaxis is managed.
1) Using rapid rhino (high volume low pressure tamponade to ensure gentle compression). These packs require analgesia and sedation 2) Require admission and O2 saturation monitoring
State a complication of epistaxis.
1) Severe bleeding 2) Hypoxia, hypercarbia 3) Sinusitis, otitis media 4) Necrosis
Define Bell’s Palsy.
Lower motor neurone weakness of cranial nerve VII (facial nerve).
State 2 symptoms of Bell’s Palsy.
Mnemonic (Bell’s) - Blink reflex abnormal. Ear sensitvity. Lacrimation: deficient, excess. Loss of taste. Sudden onset. Palsy: CN VII nerve muscles.
State a treatment of Bell’s Palsy.
Corticosteroid (symptom onset begins within 3-4 days).
State a cause of Bell’s Palsy.
Viral associated ischaemia. Epstein-Barr virus/Lyme disease.
Define a stroke.
Upper motor neurone lesion in which the lower facial muscles are affected, but forehead not affected.
State cause of facial sinusitis.
1) Acute - Gram positive and H. flu 2) Chronic - Anaerobes, gram neg
State a sign/symptom of sinusitis.
Purulent yellow-green rhinorrhea (nasal cavity filled with amount of mucous fluid). Fever
State a treatment of facial infection sinusitis.
1) Acute: amoxil, septra (both antibiotics) 2) Chronic: amoxil-clavulinic acid, clindamycin, quinolones.
State a complication of sinusitis.
1) Orbital cellulitis and abscess 2) Frontal sinusitis - may erode bone.
State a symptom of facial cellulitis.
Red, swollen, feel hot, tender on touch.
Define parotiditis.
Inflammation of the parotid salivary gland - can be acute/chronic.
State a cause of parotiditis.
1) Viral - paramyxovirus 2) Bacteria - elderly, immunocompromised; associated with dehydration
Define pharyngitis.
Sore throat.
State a cause of pharyngitis.
1) Viral infection e.g. common cold 2) Bacterial infection e.g. group A streptococcus
Define a peritonsillar abcess.
Bacterial infection which begins as complications to tonsilitis. Pus-filled pocket forms near tonsils.
State a symptom of peritonsillar abscess.
Inferior - medial displacement of tonsil and uvula. Dysphagia, ear pain, muffled voice, fever.
What defines a mild soar throat?
Able to tolerate oral fluids and medication.
What defines a moderate soar throat?
Unable to swallow fluids or oral analgesia.
What defines a severe soar throat?
Drooling saliva. Hoarse voice. Airway compromise. Signs of sepsis.
State the treatment for mild sore throat.
1) Analgesia (mild) 2) Treat with antibiotics penicillin (if more severe) 3) Treat with antibiotics clarithomycin (if allergic)
State the treatment for moderate sore throat.
1) IV fluids, IV paracetamol, benzylpenicillin + metronidazole (if penicillin allergic use vancomycin) 2) Activate full sepsis protocol
State the treatment for severe sore throat.
1) Move to RESUS (high dependency unit) 2) IV access, FBC, U&Es
State a symptom of epiglottitis.
Drooling. Changes to voice. Fever. Increased breathing rate.
State a treatment of epiglottitis.
IV antibiotics. +/- steroids. Adrenaline.
Define a retropharyngeal abcess.
Collection of pus in the back of the throat.
State 2 symptoms of a retropharyngeal abcess.
Pain. Dysphagia. Dyspnea. Fever.
State who tends to suffer from a retropharyngeal abcess.
Usually in children under 4 (lymphoid tissue in space).
Define Ludwigs Angina.
Skin condition that occurs on the floor of the mouth underneath the tongue.
What causes Ludwigs Angina?
Bacterial infection which occurs after a tooth abscess, which is a collection of pus in the center of the tooth.
State how Ludwigs angina is treated.
ICU. Antibiotics. Airway management.
Define angioedema.
Rapid swelling of area beneath the skin (normally after an allergic reaction).
State a treatment of angioedema.
Antihistamines. Steroids.
Define aphonia.
Loss of complete upper airway.
Define stridor.
Incomplete upper airway.
Define wheezing.
Incomplete lower airway.
