ENT emergencies Flashcards
otitis externa
very common
discharge pain, hearing loss, itching
see the deposit in ear, white, pus
usually s.aureus, pseudomonas
rf–water/swimmer. cotton buds, eczema, immunocomprimise
mx- swab MCS before
topical abx-NOT oral (except if systemic
aural toilet-hygene
if stenosed- put a cotton bud in then r/v
care can cause necrotising otitis externas
Necrotising otitis externa
progressive otitis externa leading to osteomyelitis
usually in diabetic pt with reccurent otitis externas. VERY VERY PAINFUL-cant sleep, no relief
caused by pseudomonas
will cause cranial nerve damage
need ENT emergency care-abx for 6w, admit, ct of temporal bones
Otitis media
classically kids tugging the ear with a temp
see a red hyperemic typaminic membrane+bulge
otalgia (pain), hearing loss–should self resolve in 2-3 days
usually viral-after URTI
mx- oral abx if bacterial/no improvement with conservative care
can perforate- and give discharge-> otitis externa-> ENT follow up-but 80% heal on own
Analgesia
recurrent-gromets
complications- facial nerve palsy, chronic perforation, MASTOIDITIS (pain/inflam behind ear, pushed forward ear)
Mastoiditis
complication of otitis media
pain/inflam behind ear, pushed forward ear
fluctuant behind ear when feel
mx- give IV abx, and CT of head- see if in the bone
cortical mastoidectomy-small incision and drain absess/wash
and gromet
Epistaxis causes and mx
Local-trauma, URTI, allergy, nasal polyps
Systemic-HTN, anticoagulant, platelet, hepatic disease
anterior»_space;>posterior
anterior-Kiesselbacks plexus
if come to you-big bleed, longterm
ABC mx
pt lean forward, pinch nose, ice
Packing, evacuate clots
topical vasoconstictor-tranexamic
pain relief-lidocaine spray
identify where-
anterior epixstatis mx
Numb nose and try to cautezisewith silver nitrate (makes skin black-normal)
if cant-just anterior packing-nasal tampons/nasopore (disolvable)
Posterior epixtasis
if packed and setted BP and not seltte
can do posterior packing-
its kinda just a foley catheter in the nose, and inflate ballon and pull back-block blood from going back, and pack the rest
after 24 still bleeding- surgery
if healed-home
Nasal fractures
common
how-punch/fall/etc-cleared from head injury?
dont need imagery for basic nose frax
exam-exclude–>septal heamatoma (boggy), and csf rhinnorhea
if concerns- trauma care- CT head
mx-ENT manipulate under anesthetic, usually between 7-14 days after (for swelling to go down)
Pyogenic granuloma
comes off septum-like a little strawberry
can/should be removed
very common in young people-cause mild epistaxis
if several recurrent polyps on one sde- think inverted papilloma
Foreign bodies ENT
child or learning difficulties
smelly nasal discharge-not getting better with drops
One sided
Tonsillitis
Strep/staph infection
sore throat, difficulties swallowing, exudate, small spots, cervical lymphadenopathy
think of infectious mononucleosis (lymphocytosis, LFTs, Monospot test)
Mx- monospot test, LFT (for glandular fever)
Analgesia, PENV
admit if really cant drink
tonsilectomy- 7 episodes in 1 year, 5 for 2years, 3/y for 3y, quinsy, cancer
1/10 bleed after, 1/100 need a 2nd one
most common bleed at d5/10-infection
Peritonsilar absecc
also known as quincy
absess next to tonsils- and shift the whole palate around-esp uvula
unilateral common. rare super rare
mx- iv fluids, iv abx, iv dex and aspirate with needle
Epiglottitis
Drooling and tripod position, look horrible, sore throat, barely voice
stridor!
usually HiB (down due to vaccin) in children
adults– many organisms
mx-dont examine throat- ask ENT anesthesia support
give adrenaline nebs
IV steroids
IV Abx-coamox
Ludwigs angina
ENT -rapidely spreading infection of submadibular space-everything gets pushed up, hard to intubate
bilateral firm swelling and pain in throat. drooling, cant swallow, cant speak
displaced tongue upwards
caused by tooth absess/infect of molars-but fast
high death rate
Mx-surgery
Abx with broadcover
CT-scan
