ENT emergencies Flashcards
Sudden decreased hearing, muffling or tinnitus w/ normal exam
* how is this treated?
- true emergency
- high dose prednisone 60mg QD x 10 days w/in 3 wks
- unilateral acute facial weakness
- unilateral herpetic rash
- hearing loss
what is this? how is it treated?
ramsy-hunt syndrome
* tx: valtrex + prednisone, urgent referral
- blood between skin and cartilage usually d/t sheering
what is this & how is it treated?
auricular hematoma
* tx: drain in 7 days & compression for 7 days to avoid reaccumulation
what can happen if auricular hematoma isn’t drained?
cauliflower ear
- Usually related to cartilage piercing & not an emergency
- infection of skin & tissue surrounding cartilage of outer ear
what is this and how is it treated?
pericondritis/auricular cellulitis
tx: oral ciprofloxacin x 7-10 days; ENT f/u
if fluctuant area, call ENT for I & D
- redness & swelling in external ear
- hearing ok, pain minimal
what is this and how is it treated?
otitis externa
* tx: cortisporin, ciprodex or cipro HC drops (4 drops BID x 7-10 days)
* if its more painful or can’t penetrate canal– do wick & add drops; f/u ENT in 2-4 days
* add oral cipro if any concern of redness or pain in auricle
tx for fungal otitis
Punt
refer to ent w/in a week
- pain, fever, fussy, decreased hearing
- bulging, red or injected TM; fluid in ear
what is this and how is it treated?
otitis media
* amoxicillin, augmentin, omnicef
drops or oral??? double check!
- URI then muffled/underwater sensation w/o otalgia or inflammation
what is this and how is it treated?
OM + effusion
tx: flonase and autoinsufflation 5-10x/day
ENT f/u in 2-4 wks
- Otalgia, less hearing acuity–> otorrhea
- Often OM dx has been made
what is this and how is it treated?
OM w/ acute TM perforation
* tx w/ oral abx + ofloxacin drops
tx for chronic TM perforation w/ otorrhea
- ofloxacin drops for otorrhea & refer to ENT in 7-10 days
- dry ear precautions
- can culture otorrhea too
tx for tympanostomy tube otorrhea (TTO)
- under 7 days: ofloxacin, ciprodex or CiproHC drops
- over 7 days/failing drops: drops + oral augmentin or omnicef
tx for functioning tube but has red ear w/o otororrhea
NO ABX
tx for traumataic TM perforation
Ofloxacin for 7 days, dry ear precaution
Ent f/u in 7-10 days then again in 4-6 wks
NOT AN EMERGENCY
which two conditions have dry ear precaution
Traumatic TM perforation
Chronic TM perforation w/ otorrhea
describe episaxis management
- Pressure & Lidocaine-Afrin cottonball anesthesia; alternate w/ cautery
- After cautery– abx ointment nightly x 1 month; saline mist in daytime
- if cautery fails, add a pack; ENT referral in 3-7 days
when do you give abx with epistaxis management
only if cautery fails, youre referring to ENT but the time to see ENT is longer than 3 days!
general policies when managing ear foreign body (2)
- don’t go past middle part of ear canal
- use ofloxacin drops if needed or ENT consult in 1 wk if needed
if insect in ear, what can you do to help remove it?
add alcohol or mineral oil and wait for it to croak
- Unilateral smelly rhinorrhea
what is this and how do you tx it
nasal foreign body
* can use lido/afrin spray while removing along with tools; amoxicillin if it fails
* ENT f/u within 1 week
- Facial pain & pressure + new postnasal drainage
what is this and how do you treat it
sinusitis– can look in middle meatus
* abx + predinsone
* imaging or referral after 2 failed rounds of tx
abx– augmentin or omnicef
tx of strep tonsilitis
PCN or amoxicillin
tx of mono tonsilitis
steroids– dexamethasone or medrol dose pack
6 consequnces of untreated strep infection
- Rheumatic fever
- reactive arthritis
- scarlatina
- toxic glomerulonephritis
- sydenham chorea
- guttate psoriasis
- Miserable patient with severe unilateral sore throat, trismus (hot potato voice), dysphagia
- Unilateraledema & erythema of anterior pillar
what is this and how is it treated?
peritonsilar abscess
urgent ENT referral for I & D
miserable patient with floor of mouth infection, lifting tongue, usually elderly w/ bad teeth
ludwigs angina
supraglottic infection & swelling, usually in kids
epiglottitis
subglottic infection of the trachea and bronchial tree, usually in kids
bacterial tracheitis
d/t penetrating trauma to mouth (usually fall w/ straw) usually kids; or progression of peritonsillar abscess
retropharngeal abscess
“Secure airway, IV meds, CT scan and call ENT” is used to treat which 4 conditions?
ludwigs angina
epiglottitis
bacterial tracheitis
retropharyngeal abscess
