ENT emergencies Flashcards
2 main blood supplies to the nose
- ICA
2. ECA
where is most common site of nose bleeds
little’s area
- at location of kisselbach’s plexus
- large anastamosis
7 general local causes of epistaxis and most common
- trauma - most common
- barometric changes
- dryness
- septal perf
- chem
- tumors
- inflammation
3 general systemic causes of epist
- coagulopathies
- granulomatous disorders
- vascular
8 things to assess in initial epist
- airway patnecy
- vitals
- maintain P on nose
- assess blood loss and side of bleeding
- PmHx
- IV access if indicated
- bloodwork
- CBC
- INR/PTT
3 keys to exam
- good light
- suction
- anasthesia/vasoconstriction
increasing steps of mgmt of epistax
- silver nitrate - chem cautery
- gelfoam or surgicel - absorbable
- inflatable nasal cath - tamponade
- merocel sponge - absorbes
- vaseline gauze
if none work, then what
- patient coagulopathy?
- HT?
- pack inadequate
- bleed posterior?
what to do for posterior bleed
posterior pack - trace a foley cath back in
what if posterior pack dont work (2)
- embolization - can only do ECA
2. surgical ligatio
where does infection accumulate in necks
in the spaces
- between fascia
most common Sx of neck space infection (2)
- sore throat
2. odynophagia
Sx that tell you there is something more nefarious happeneing
- fever
- decreased PO
- otalgia
- neckpain
- toricollis
- swelling
6 most common causes
- odontogenic
- tonisllitis/pharyngytis
- sialodentis
- IV drugs
- trauma
- iatrogenic
main imaging for neck
CT
3 main aspects of mgmt
- airway protectiong
- antimicrobials
- Gr- cocci
- anaerobes - most need surgical drainage
5 possible complicatios of neck space infection
- airway obs
- mediastinitis
- sepsis
- IJV thrombosis - throw clots all over
- life threatenin hemmorage
def. of sudden SN hearing loss
hearing loss in 3 cont. hx of 30dB
- onset in less than 24 hrs
- normal middle ear
- EMERGENCY
4 parts of work-up for sudden hearing loss
- complete H+P
- audiogram
- labs
- MRI gadolinium
Tx of sudden loss
systemic prednisone
- can possibly do intratympanic
what is bell’s palsy
acute but limited facial palsy
- rapid onset
- diagnosis of exclusion
- idiopathic
what is outcome
paresis - 95% recover
paralysis - 71% recover
Tx of bell’s
obseve
- roids in first couple of weeks.
