ENT Emergencies Flashcards

1
Q

ENT emergencies of the ear (2)

A

foreign bodies

malignant otitis externa

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2
Q

ENT emergencies of the Nose/Sinus (5)

A
foreign bodies
epistaxis
nasal fracture
septal hematoma
complications of sinusitis
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3
Q

ENT emergencies of the oropharynx (2)

A

Ludwig’s angina

Peritonsillar abscess

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4
Q

ENT emergency of the salivary gland (1)

A

sialoadenitis

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5
Q

Which ENT emergency is usually visualized easily and has a primary symptoms of pain?

A

foreign body in the ear

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6
Q

If there is a live insect in the patients ear, what should you do first?

A

Immobilize insect with 2% Lidocaine or mineral oil

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7
Q

How to remove a foreign body in the ear

A

Alligator forceps
sometimes suction
can try irrigation
If deeply impacted FB, may need to refer to ENT
sometimes FB removal rqrs general anesthesia or conscious sedation

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8
Q

Cauliflower Ear: 2 sporty aliases

A

Wrestler’s ear, boxer’s ear

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9
Q

(U) cause of cauliflower ear

A

blunt trauma

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10
Q

What is cauliflower’s ear and does it need to be treated?

A

Cauliflower’s ear is hematoma of the pinna

if untreated, it may result in cartilage necrosis, chronic scarring & deformity

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11
Q

Laceration of the Pinna: characteristics, what to watch for & how to tx

A

(U) bleeds a lot
Make sure there is no injury to the canal & internal ear
Watch out for hemotomas
If laceration needs to be repaired, (U) a running suture is best

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12
Q

How can one obtain perichondritis?

A
  • ear piercing, particularly to upper third of the pinna can result in ear infections
  • cartilage is avascular, improper healing can predispose to infection (Pseudomonas and Staph)
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13
Q

Which two microbes are common in perichondritis?

A

Pseudomonas

Staph aureus

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14
Q

Signs/sxs of perichondritis

A

pain, erythema & localized warmth

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15
Q

Perichondritis treatment: why and what

A

infections can spread rapidly & lead to deformity

Antibiotics required; surgical debridement

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16
Q

Malignant Otitis Externa: broad 1 line definition

A

invasive infection that involves the temporal bone!!!!

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17
Q

In whom do we see Malignant Otitis Externa

A

IMMUNOCOMPROMISED PATIENTS (diabetics, elderly, systemic malignancy, long term steroid use)

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18
Q

Malignant Otitis Externa primary pathogen

A

Pseudomonas aeruginosa

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19
Q

Malignant Otitis Externa a/w which symptoms

A

severe, unrelenting ear pain that is worse at night

a/w purulent otorrhea

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20
Q

As Malignant Otitis Externa spreads, what 3 things may be seen

A

trismus
cervical adenompathy
CN palsies

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21
Q

Malignany Otitis Externa: clinical presentation & dx

A

ear canal edematous & erythematous w/granulation tissue

CT scan will be DIAGNOSTIC

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22
Q

Malignant Otitis Externa: ENT referral for which situations

A

admission

IV antibiotics: Imipenem or ciprofloxacin or ceftidime

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23
Q

Mastoiditis: definition

A

extension of otitis externa or acute otitis media into mastoid air cells

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24
Q

Mastoiditis: signs & symptoms

A

suspect w/slow resolution of sxs
Mastoid tenderness with edema & erythema
Deep temporal pain

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25
Q

Mastoiditis: diagnostic studeis

A

CT is BEST diagnostic study

plain x-rays might show density in mastoid airspace but may nito be discernible until 2 weeks after onset of mastoid infection

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26
Q

Mastoiditis: Tx & prognosis

A
  • Hospitalize & start on IV Abx (Vancomycin or Nafcillin/Oxacillin)
  • typmanocentesis for fluid to culture
  • mastoidectory required if complications

prognosis is good :)

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27
Q

What is the most likely etiology of malignant otitis externa?

A

Pseudomonas

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28
Q

Epistaxis: most common etiology

& other causes of epistaxis

A

TRAUMA is most common
others: FB, irritants (cig smoke), HTN, nose picking,
meds (ASA, NSAIDS, anticoagulants)
hematologic disorders; hemophilia, leukemia, platelet dysfunction, thrombocytopenia

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29
Q

Epistaxis physical exam (3 management elements)

A
  • sitting position preferable to supine
  • initial management: direct pressure for a minimum of 5 mins
  • ensure hemodynamic stability & airway patency
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30
Q

Epistaxis: equipment used is in physical exam

A
  • bright light source (headlight)
  • nasal speculum
  • adequate suction
  • adequate protection against blood exposure (goggles, apron, gloves)
  • adjustable chair (ENT or dental chair)
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31
Q

Epistaxis: usual source of bleeding in kids

A

Kiesselbach’s Plexus

anteriorly on the nasal septum branch of the labial artery

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32
Q

Epistaxis: adult usual source of bleeding

A

in septum, but more posterior than kids

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33
Q

Epistaxis: elderly usual source of bleeding

A

elderly (U) most difficult to identify & control
branch of the MAXILLARY ARTERY
POSTERIOR, harder to visualize
more bleeding, more systemic factors

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34
Q

Anterior nose bleed tx

A

Topical vasoconstrictors: 2%Neo-synephrine spray, 4% cocaine spray or solution on cotton pledgets

Cautery: chemical (silver nitrate), hemostatic packing material-Gelfoam or Surgicel, electrocautery

Anterior packing: petrolatum-impregnated gauze packed firmly in the anterior nares with forceps, leave for 48 hours (preformed nasal tampon may be used)

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35
Q

Posterior nose bleed tx and complications

A

Vasoconstrictor: pledgets saturated in 4-5% cocaine
Anterior packing
Posterior packing:
-posterior pack + anterior nares bilaterally
-balloon catheter: left in place for 2-5 days
-HOSPITALIZE if posterior pack or balloon catheter

Complications: septal hematoma, sinusitis, toxic shock syndrome

36
Q

Nasal fracture: (U) cause, may be a/w what

A

very common injury, (U) from blunt trauma

-may have associated epistaxis (need to evaluate for septal hematoma)

37
Q

non-displaced nasal fracture: immediate needs

A

generally don’t require immediate intervention
ENT referral in 3-5 days

BLOOD w/surrounding STRAW-COLORED FLUID OR SEROUS FLUID->think other facial fractures, need URGENT NEUROSURGICAL consultation

38
Q

Septal hematoma: When seen, (C) in whom

A

seen following trauma

more common in pediatric patients

39
Q

Septal hematoma: symptoms (3), Physical exam (3)

A

sxs: increased nasal obstruction, pain, tenderness

PE: soft, tender, swelling

40
Q

Nasal Hematoma tx

A

-incision & drainage of hematoma to prevent avascular necrosis
[untx hematomas complicated by “saddle nose” deformity]
after drainage, pack nose and cover w/antibiotics

41
Q

When do you avoid irrigation of the nose

A

if foreign body is vegetable matter

42
Q

What can you have a parent do if their child has a foreign body in his mose?

A

can have parent try to blow it out

43
Q

What is necessary for nose foreign body removal in a child

A

child must be adequately restrained and you must have good visualization

44
Q

When do you refer nasal FB to ENT

A

if more than 2 unsuccessful attempts, refer to ENT

45
Q

Foreign body in nose: when to re-examine

A

ALWAYS re-examine after 1 FB removed

46
Q

4 potentially life-threatening complications of sinusitis

A

[result from extension of a bacterial infection into the orbital or intracranial spaces]

  1. Periorbital cellulitis
  2. Orbital cellulitis
  3. Cavernous sinus thrombosis
  4. Frontal osteomyelitis
47
Q

Periorbital Cellulitis def & may be a complication of what

A

infection confined to the eyelids, may be a complication of sinusitis or local disruption of skin

48
Q

Periorbital cellulitis: 2 most common pathogens

A

S. pneumo

S. aureus

49
Q

Periorbital cellulitis: ddx includes (3)

A

trauma, contact allergy, dacryocystitis

50
Q

Periorbital cellulitis: symptoms (4)

A

unilateral periorbital edema with erythema, warmth, tenderness, fever

51
Q

Physical exam findings suggestive of ORBITAL cellulitis

A

VISION LOSS, DIPLOPIA, & PROPTOSIS suggest intraorbital involvement consistent with orbital cellulitis

[on exam, assess visual acuity & EOMs)

52
Q

Perioribital Cellulitis: dx & tx

A

-CT scan most helpful to dx
-hospitalize anyone who is febrile & appears acutely ill
-IV Abx
-consult ophthamologist and/or ENT
prognosis is good if tx started early

53
Q

Orbital cellulitis can lead to what

A
TRUE EMERGENCY, can lead to:
vision loss
meningitis
cavernous sinus thrombosis
frontal abcess
54
Q

Orbital Cellulitis: what will you see

A

periorbital edema, erythema PLUS proptosis, chemosis, impaired EOMs & evidence of vision loss

55
Q

Orbital cellulitis dx

A

CT WILL DISTINGUISH between periorbital cellulitis and orbital cellulitis

56
Q

Orbital cellulitis tx

A

Admit for IV Abx:

Nafcillin + Ceftriaxone + Metronidazole

57
Q

Cavernous Sinus Thrombosis Sxs

A

sxs develop acutely, w/in 1 week after infection

  • severe unilateral, retro-orbital headache
  • bilateral proptosis
  • ophthalmoplegia
  • vision loss
  • SENSORY DYSFUNCTION: hypo-/hyperesthesia of cranial nerve V, 1st branch
58
Q

Sensory nerve dysfunction on Cavernous Sinus Thrombosis is due to

A

hypo-/hyperesthesia of Cranial Nerve V, 1st branch

59
Q

Cavernous Sinus Thrombosis appearance on exam

A

Febrile, toxic appearing pt
Periorbital edema
Cranial Nerve dysfunction (III, IV, VI)
Papilledema (late)

60
Q

Cavernous Sinus Thrombosis: dx and tx

A

need URGENT head CT

IV Abx: Vancomycin + Ceftriaxone

61
Q

Frontal Osteomyelitis aka & a/q

A

Pott’s Puffy Tumor

is a complication a/w frontal sinusitis

62
Q

Frontal Osteomyelitis most common microbes

A

S. aureus & anaerobes

63
Q

Frontal Osteomyelitis: patient presentation

A

patient presents w/HA & progressive swelling of the forehead

64
Q

Frontal Osteomyelitis dx

A

CT or MRI will be dx

65
Q

Frontal Osteomyelitis tx

A

drainage of abscess & debridement of infected bone

IC Abx: Vancomycin or Nafcillin

66
Q

Tongue laceration: cause & what is the problem

A

(U) related to injury, frequently involving the teeth

Great potential for INFECTION & HEMATOMA

67
Q

Tongue Laceration tx

A

almost never sutured, exception: tip of tongue (forked tongue)

  • may need to suture if more than 1/3 of the width of the tongue involved
  • absorbable suture material, Abxs
68
Q

Puncture wounds in the mouth: etiology, description

A

common but rarely serious
running with something in mouth or run into something
almost always small
bleeding resolves spontaneously

69
Q

Puncture wounds in mouth tx

A
  • start on Abx (possibly only when more serious?)
  • rinse w/ warm water after every meal
  • will resolve without tx
  • topical anesthesia for pain control
  • can use orabase dental paste to prevent irritation, but doesn’t speed healing
  • solution of Maalox & liquid Benadryl (1:1)
70
Q

What ENT condition presents with uvula displacement?

A

Peritonsilar abscess

71
Q

Ludwig’s Angina: what is this?

A

infection involving the submandibular space

potential spread can compromise oral cavity, airway & deep neck spaces

72
Q

85% cases of Ludwig’s Angina are the result of what

-can also see with what?

A

85% are the result of a dental infection

-can also see with a peritonsillar abscess, oral malignancy or mandibular fracture

73
Q

Ludwig’s Angina: 3 common pathogens

A

Streptococcus, Staphylococcus & Bacteroides

74
Q

Ludwig’s Angina sxs and associated conditions

A
  • rapidly progressive infection a/w neck swelling, tongue protrusion & severe pain
  • also see malaise, trismus & bad breath
75
Q

Ludwig Angina: tx

A
  • ENT consultation for potential airway compromise & surgical debridement
  • IV Abx
76
Q

Most common abscess of the head and neck

A

peritonsillar abscess

77
Q

“hot potato” voice seen in

A

peritonsilar abscess

78
Q

Signs and symptoms of peritonsilar abscess

A

fever, severe sore throat, drooling odynophagia & otalgia

signs: trismus, unilateral erythema & swelling, displaced uvula

79
Q

Peritonsillar Abscess tx

A

drainage of abscess and Abx

80
Q

Sialoadenitis: definition, etiology, 2 types

A
  • inflammation of any of the salivary glands (parotid, submandibular, sublingual)
  • viral or bacterial etiology

Forms:
Suppurative-most(C)cause:Staphylococcous aureus
Obstructive-occurs fro a stone or calculus in salivary gland or duct

81
Q

Sialoadenitis presentation

A

pts are: elderly, diabetic, poor oral hygiene, dehydration
-enlarged, swollen, painful mass
w/stone: xerostomia & worsening pain & swelling during mealtime

82
Q

Bilateral swelling of a gland may be due to

A

VIRAL sialoadenitis

83
Q

Bacterial Sialoadenitis presents: (Uni or bi-laterally)

A

UNILATERAL

84
Q

Viral Sialoadenitis presents (uni- or bi-laterally)

A

BILATERAL

85
Q

Unilateral swelling of a gland may be due to

A

bacterial sialoadenitis

86
Q

Tx of sialoadenitis

A

Suppurative: Abx tx to cover Staph
Rehydration, proper oral hygiene
surgical irrigation & drainage

Obstructive: most stones pass spontaneously without complication
lozenges to stimulate salivary secretions

87
Q

Serum amylase will be elevated in which ENT Emergency lecture condition?

A

Sialodenitis