ENT emergencies Flashcards
what medication can you use to immobilize insects in ear
- 2% lidocaine
- mineral oil
cauliflower ear
- hematoma of the pinna
if a laceration to pinna needs suturing, what technique is the best
- running suture
perichondritis
- infection of the skin and tissue surrounding the cartilage of the outer ear.
malignant otitis externa is an invasive infection that involves what bone
- temporal bone
malignant otitis externa is seen in what patient population
- immunocompromised patients
primary pathogen: malignant otitis externa
- pseudomonas aeruginosa
how is malignant otitis externa diagnosed
- CT scan
mastoiditis is caused by an extension of
- otitis externa or acute otitis media into mastoid air cells
how is mastoiditis diagnosed
- CT best
tx of mastoiditis
- hospitalize
- IV abx: vancomycin or Nafcillin/Oxacillin
most common etiology of epistaxis is
- trauma
initial management of epistaxis
- direct pressure for a minimum of 5 minutes
source of bleeding in children
- kiesselbach’s plexus
- source usually anteriorly on nasal septum, branch of labial artery
source of bleeding in adults
- posterior setpum
source of bleeding in elderly
- branch of maxillary artery
- posterior
- more bleeding
treatment options for an anterior epistaxis
- topical vasoconstictor
- neo-synephrine spray
- cocain spray
- cautery
- anterior packing with petrolatum
treatment options for an posterior epistaxis
- vasoconstrictor
- posterior packing -> hospitalization
- balloon catheter left in place for 2-5 d
complications of posterior packing for epistaxis
- septal hematoma
- sinusitis
- toxic shock syndrome
tx for non-displaced nasal fracture
- ENT referral 3-5 d
what should you do if a patient with nasal fracture presents with blood surrounding straw-colored fluid or seroud fluid
- CSF lead
- urgent neurosurgical consultation
septal hematoma are most common in what patient population
- pediatric
tx of septal hematoma
- incision and drainage of hematoma to prevent avascular necrosis
- following drainage, pack nose and cover with abx
untreated septal hematomas are complicated by
- “saddle nose” deformity
what should be avoided if pt presents with vegetable foreign body in nose
- avoid irrigation
if more than unsuccessful attempts to remove FB from nose, refer to ENT
- two
List complications from sinusitis
- periorbital cellulitis
- orbital cellulitis
- cavernous sinus thrombosis
- frontal osteomyelitis
infection with periorbital cellulitis is confined to
- the eyelids
most common pathogens causing periorbital cellulitis
- Strep. pneumo
- S. aureus
on exam of periorbital cellulitis, assess visual acuity and EOMS because
- vision loss, diplopia, and proptosis suggest intraorbital involvement consistent with orbital cellulitis
how is periorbital cellulitis diagnosed
- CT
what imaging can differentiate between periorbital cellulitis and orbital cellulitis
- CT
orbital cellulitis is a true emergency and can lead to
- vision loss
- meningitis
- cavernous sinus thrombosis
- frontal abscess
clinical presentation
- periorbital edema
- erythema
- proptosis: protrusion of eyeball
- chemosis: swelling of conjunctiva
- impaired EOMs
- vision loss
- orbital cellulitis
tx of orbital cellulitis
- admit
- Nafcillin + Ceftriaxone + Metronidazole
clinical presentation
- severe unilateral, retro-orbital headache
- bilateral proptosis
- opthalmoplegia
- vision loss
- sensory dysfunction - hypo/hyperesthesia of cranial nerve V1
- CN dysfunction (III, IV, VI)
- cavernous sinus thrombosis
how is cavernous sinus thrombosis diagnosed
- CT
tx of cavernous sinus thrombosis
- IV
- vancomycin + ceftriaxone
common pathogens causing frontal osteomyelitis
- s. auerus
- anaerobes
clinical presentation
- h/o frontal sinusitis
- HA
- progressive swelling of forehead
- frontal osteomyelitis
how is frontal osteomyelitis diagnosed
- CT or MRI
tx of frontal osteomyelitis
- drainage of abscess and debridement of infected bone
- IV abx: vancomycin or nafcillin
tongue lacerations are alomst never sutures except those located
- tip of tongue
- if > 1/3 width of tongue is involved
define Ludwig’s angina
- infection involving the submandibular space
- 85% result of dental infection
common pathogens causing Ludwig’s angina
- streptococcus
- staphylococcus
- bacteroides
clinical presentation
- neck swelling
- tongue protrusion
- severe pain
- fever, malaise, trismus, bad breath
- Ludwig’s angina
most common abscess of head and neck
- peritonsillar abscess
clinical presentation
- fever
- severe sore throat
- drooling
- odynophagia
- otalgia
- “hot potato” voice
- uvula displaced, unilateral erythema and swelling
- peritonsillar abscess
what is Sialoadenitis
- inflammation of any of the salivary glands
- parotid
- submandibular
- sublingual
suppurative Sialoadenitis most commonly caused by
- staph aureus
Sialoadenitis most commonly found in what patient population
- elderly
- diabetic
- poor oral hygiene
bilateral Sialoadenitis etiolgy
viral
unilateral Sialoadenitis etiolgy
- bacterial
obstructive Sialoadenitis caused by
- stone or calculus in gland or duct
- most stones pass spontaneously without complication
