ENT Emergencies Flashcards
Treatment of auricular hematoma?
- I+D or aspiration prior to cartilage necrosis
- if I +d, leave drain to facilitate drainage
- antibiotics (need to cover skin flora)
- 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
barotrauma
- 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
hemotympanum
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
Cerumen impaction
How do you treat cerumen impaction?
- 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
- 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
TM perforation
- 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
epistaxis
management of epistaxis?
- have patient hold pressure
- evacuate clots
- topical vasoconstrictor- oxymetazoline
- identify source
management of removing foreign body from the ear?
- irrigation (contraindicated for organic matter or seeds)
- suction
- alligator forceps
- superglue (cyanoacylate adhesives) use carefully in special cases
nasal foreign body removal?
- 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
when evaluating facial fractures what does hypoesthesia suggest? decreased sensation in the chin? trismus?
- 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
- usually viral (paramyxovirus)
- bacterial (elderly, immunocompromised)
- management: cover staph, anaerobes (e.g, clindamycin); hydrate, sialogogues, warm compresses, pain control
Parotitis
- 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
peritonsillar abscess
what is the causative organisms of peritonsillar abscess? treatment
causative organisms: Group A strep, strep pyogenes, Staph Aureus. H. influenzae, anaerobes
treatment: antibiotics (PCN, clindamycin, augmentin), Incision and drainage, steroids, pain control
- 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
epiglottitis
how should epiglottitis be evaluated? what would you see? What are treatment option?
- direct visualization if patient allows
- soft tissue X-ray of neck: lateral view shows thumb print
- treatment: antibiotics, steroids
- 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
retropharyngeal abscess
- 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
Ludwig’s angina
clinical presentation of ludwig’s angina?
- 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
- 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
angioedema
management of airway obstruction?
ABCs- think airway (may require intubation
likely ICU admission
drain the abscess
IV antibiotics: penicillin, clindamycin, flagyl
