ENT Emergencies Flashcards

1
Q

Treatment of auricular hematoma?

A
  • I+D or aspiration prior to cartilage necrosis
  • if I +d, leave drain to facilitate drainage
  • antibiotics (need to cover skin flora)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • ear discomfort due to pressure changes (airplane, scuba diving, driving mountains etc.) eustachian tube blockage or ear infection
  • on exam TM bulges outward or inward slightly
  • treatment: yawning, chewing gum, decongestants, antibiotics if infection
A

barotrauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • Blood in the typmanic cavity of middle ear
  • often due to basilar skull fracture (usually temporal bone, occipital bone, sphenoid bone, ethmoid bone
  • treatement: address underlying condition
A

hemotympanum

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

patients present with
* ear pain or fullness
* difficulty hearing
* ringing in the ears
* discharge or odor

Always abnormal
* more common in elderly, those with hearing aids, developmental disabilities, abnormal canal shape, cotton swab use

A

Cerumen impaction

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

How do you treat cerumen impaction?

A
  • ceruminolytics (water or oil based)- docusate sodium, olive oil
  • irrigation(using synringe with soft tipped catheter from butterfly needle) make sure to use warm water!
  • manual removal
  • can often be a combination of the above
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  • secondary to infection, direct trauma
  • assess and document hearing
  • treat by keeping ear dry, close observation; if infection treat with antibiotics
  • avoid cortisporin products use ofloxacin otic, ciprofloxacin
  • usually heals spontaneously within a few weeks
  • larger ones may require surgery
A

TM perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • anterior bleed is more common (90% anterior bleed (kisselbach’s plexus) usually kids
  • 10% posterior- usually in the elderly
  • local: trauma, nasal foreign body, URI, allergies, low humidity
  • systemic: HTN, hemophilia, leukemia, platelet dyfunction
A

epistaxis

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

management of epistaxis?

A
  • have patient hold pressure
  • evacuate clots
  • topical vasoconstrictor- oxymetazoline
  • identify source
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

management of removing foreign body from the ear?

A
  • irrigation (contraindicated for organic matter or seeds)
  • suction
  • alligator forceps
  • superglue (cyanoacylate adhesives) use carefully in special cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

nasal foreign body removal?

A
  • positive pressure (farmer’s blow, mothers kiss)
  • alligator forceps or hooked probe
  • balloon catheter (after coating with lidocaine jelly, insert past object inflate balloon and withdraw
  • suction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when evaluating facial fractures what does hypoesthesia suggest? decreased sensation in the chin? trismus?

A
  • hypoesthesia in the region of the infraorbital and supraorbital nerve may suggest an orbital fracture
  • decreased sensation of the chin may result from inferior alveolar nerve compression from a mandibular fracture
  • trismus can be sencondary to mandibular or zygomatic fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • usually viral (paramyxovirus)
  • bacterial (elderly, immunocompromised)
  • management: cover staph, anaerobes (e.g, clindamycin); hydrate, sialogogues, warm compresses, pain control
A

Parotitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • complication from acute/chronic tonsillitis
  • cellulits of the space behind tonsillar capsul extending onto soft palate leading to abscess
  • SX: Unilateral throat pain, dysphagia, ear pain, muffled voice, fever, trismus
A

peritonsillar abscess

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

what is the causative organisms of peritonsillar abscess? treatment

A

causative organisms: Group A strep, strep pyogenes, Staph Aureus. H. influenzae, anaerobes

treatment: antibiotics (PCN, clindamycin, augmentin), Incision and drainage, steroids, pain control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • acute inflammation causing swelling of the supraglottic structures of the larynx
  • older children & adults
  • decrease in incidence in children secondary to HIB vaccine
  • onset rapid, patients look toxic
  • prefer to sit, muffled voice, dysphagia, drooling, restlessness
A

epiglottitis

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

how should epiglottitis be evaluated? what would you see? What are treatment option?

A
  • direct visualization if patient allows
  • soft tissue X-ray of neck: lateral view shows thumb print
  • treatment: antibiotics, steroids
17
Q
  • anterior to prevertebral space and posterior to pharynx
  • usually in children under 4 (lymphoid tissue in space)
  • sx: pain, dysphagia, dyspnea, fever
  • diagnosis welling of retropharyngeal space on lateral x-ray: often CT of soft tissues of neck
  • complication mediastinitis
  • treatment: IV abx, hydration, pain control, surgery
A

retropharyngeal abscess

18
Q
  • rapid bilateral spreading cellulitis/inflammation with possible abscess formation of superior compartment of suprahyoid space
  • caused by streptococcus or oral anaerobes
  • usually in elderly debilitated patients and precipitated by dental procedures
  • massive swelling with impending airway obstruction
A

Ludwig’s angina

19
Q

clinical presentation of ludwig’s angina?

A
  • very tender swelling under mandible +floor mouth
  • usually little or no fluctuance
  • severe trismus, drooling of saliva
  • gross swelling, elevation, displacement of tongue
  • tachypnea and dyspnea may happen
  • danger of upper airway obstruction & death
20
Q
  • occassionally life threatening
  • acquired: IgE mediated: vasodilation and increased vascular permeability (i.e, insect bites, food etc) not IgE mediated (I.e Ace inhibitors)
  • hereditary
  • treatment: O2, anti-histamine, steroids, epinephrine
  • consider intubation if airway compromise
A

angioedema

21
Q

management of airway obstruction?

A

ABCs- think airway (may require intubation
likely ICU admission
drain the abscess
IV antibiotics: penicillin, clindamycin, flagyl