ENT Emergencies Flashcards
Which is prefered if you are not an experienced surgeon and need an immediate surgical airway? Why?
Cricothyrotomy or tracheotomy?
Cric - easier and less bloody , only a knife
During a cric while you are putting in the endotracheal tube, make sure you do not push it past the ______?
Carina
What is the name of the congenital disorder in which the nasal choana is occluded by soft tissue, bone or both.
How does it present unilaterally vs bilaterally?
Which one is the emergency and what can be done prior to surgery to help?
Choanal atresia.
Unilateral: unilateral mucopurulent discharge
Bilateral: neonate unable to breath - emergency bc newborns are obligate nasal breathers. A montgomergy nipple can be used.
Syndrome common in young, muscular, overweight men with short necks. Why can this be a problem?
Macroglossia
Can result in difficult laryngeal exposure, and therefore difficult to intubate.
What is another name for congenital micrognathia?
Why can this be a problem?
Pierre Robin Syndrome - can result in difficult laryngeal exposure, and therefore difficult to intubate.
This infection of the floor of the mouth most commonly caused by infection of the teeth that can cause the tongue to be pushed up and back, obstructing the airway
Ludwig’s angina
Ludwig’s angina present with unilateral or bilateral neck swelling? Also redness, pain and fever
How can you treat it?
- Unilateral
- Incision and drainage of the abscess over the submandibular swelling with abx covering oral cavity anaerobes. usually require awake tracheotomy due to rapid infection
In Ludwig’s angina, if teeth of the 2nd and 3rd molars are abscess, the pus will go into the (sublingual or submandibular space)?
This may spread to where?
Submandibular (the molar roots are behind and below the mylohyoid)
Parapharyngeal space.
In Ludwig’s angina, if the first molar is abscessed, the pus will go into the (sublingual or submandibular space)?
Sublingual (the molar root is above and in front of the mylohyoid)
What is the etiology of acute supraglottic swelling?
What can this result in?
Functional or quantitative deficiency of C1-esterase inhibitor.
Can cause dramatic swelling of the tongue, pharyngeal tissues, and supraglottic airway.
How can you treat acute supraglottic/angioneurotic edema?
IV steroids, H1 and H2 histamine blockers.
What is this sign called?
Manifestation of an oedematous and enlarged epiglottis which is seen on lateral soft-tissue radiograph of the neck, and it suggests a diagnosis of acute infectious epiglottitis.
Thumb sign
Acute supraglottic swelling/epiglottis present with noisy breathing, high fever, drooling, and a characteristic posture described as ________
Sitting upright with jaw thrust forward
Epiglottis can occur as a result of what infection?
Why is this less common?
- H. influenzae
2. Vaccine against H influenza
What is this? Collection of purulence in the space bw tonsil and pharyngeal constrictor.
Tx?
Peritonsillary abscess
Tx: drain/aspirate, pain control, abx, possible tonsillectomy
Patients with peritonsillar abscess will usually have untreated sore throat for several days that gets worse on one side. What are other hallmark signs of peritonsillar abscess?
Full anterior tonsillar pillar
Uvular deviation away from side of abscess
Hot potato voice
Trismus (diff to open jaw)
What type of forceps are used to extract foreign bodies in the pharynx or laryngeal inlet?
Why would you need suction?
Magill
Patient will usually vomit.
What is an explanation for a child with unexplained cough or pneumonia?
Foreign body aspiration
A ball valve obstruction (block flow of gas in 1 direction, but allow flow in in the other) results in hypo or hyperinflation of the obstructed lobe?
Hyperinflation
What is the fungal infection of the sinonasal cavity that occurs in immunocompromised hosts (BM transplants or chemo) called?
Mucormycosis
Why is there significant mortality assoc w/mucormycosis and in who?
can be invasive (grows into blood vessels –> thrombosis and distal ischemia –> tissue necrosis)
Pts: diabetics (poor glucose regulation who become acidotic). Also pts w/renal failure.
How does mucormycosis spread?
sinuses –> nose, eye, palate –> optic nerve –> brain
- How does mucormycosis present?
- What does it look like on biopsy?
- How to treat?
- facial pain (black turbinates due to necrosis of mucosa)
- acutely branching nonseptate hyphae
- Immediate correction of acidosis (metabolic stabilization) so general anesthesia is tolerated –> debride (radical maxillectomy/orbital exenteration)
Amphotericin B
Where does epistaxis most commonly occur?
Most common initiating event for these nosebleeds
Anterior part of the septum (Kiesselbach’s plexus)
Digital trauma
How to tx nosebleeds in kids and adults with hypertension and epistaxis?
oxymetazoline or phenylephrine (topical vasoconstriction) nasal spray and digital pressure for 5–10 min
Possible causes of epistaxis besides digital trauma?
occult bleeding disorder;
Cocaine abuse
Adults with hypertension and arthritis
Bleeding from the back of the nose in an adolescent MALE is considered to be ____ until proven otherwise
Juvenile nasopharyngeal angiofibroma
adults with hypertension and epistaxis should be tx w/med to dec BP so diastolic is below ____ mgHg
90
what does methycellulose coated w/abx ointment do for epistaxis? how long do you use it?
can be placed in the nose to prevent further trauma and allow mucosal surfaces to heal. Put in for 3-5 days
If bleeding isnt stopped ___ is used as a pressure method to stop the bleeding.
If anterior and unilateral patients may go home.
If bilateral then patients need to be admitted
Packing for 3-5 days
Severe nosebleeds can lead to what?
hypovolemia
significant anemia
Severe infection of the external auditory canal caused by ____ organisms
- Necrotizing otitis externa/malignant otitis externa
2. pseudomonas
Necrotizing otitis externa can spread to the ___ bone which is called ___ and can extend to __
temporal
osteomyelitis
base of the skull
necrotizing otitis externa commonly occurs in what type of patients?
older patients with diabetes (traumatic instrumentation or irrigating wax) or AIDS patients
presentation of necrotizing otitis externa
deep ear pain, temporal headaches, purulent drainage and granulatino tissues at bony cartilaginous jcn in EAC and facial nn
Cranial neuropathies
How do you diagnose and tx necrotizing otitis externa?
Dx: CT scan of the bone w/bone windows; technetium bone scan shows hot spot.
Tx: glucose control, aural hygiene, topical antipseudomonal abx (QUINOLONES), hyperbaric o2
Sudden SNHL is idiopathic, unilatearl and occurs in less than ___ hours. It is a medical emergency!
72
- Sudden SNHL etiology.
2. Most common tx
- viral infection or a disorder of inner ear circulation due to vascular disease.
- tapered course of oral corticosteroids and/or intratympanic corticosteroid injections
