ENT emergencies Flashcards
Exam 2
Common ear emergencies
- Otitis externa (swimmer’s ear)
- acute otitis media
- foreign body
- perforated eardrum
- sudden hearing loss
Otitis externa presentation
- hx of trauma or swimming
- itching and pain
- drainage, hearing loss
- swelling, erythema, fever, lymphadnopathy
Otitis externa causes
- Localized: staph
- Diffuse: pseduomonas
- fungal
- allergic
- seborrheic
Otitis externa tx
- cleansing/debridement (typically fungal)
- drops
- oral abx
- wick
- pain meds
- neomycin-boric acid powder
- culture
Otitis externa emergency
- sx: diplopia, facil paralysis
- comorbitites: DM, immunocompromised
Acute otitis media presentation
- children age 2
- fever, pain, irritability, purulent drainage, other URI sx
- HEARING LOSS
Acute otitis media organism causes
- viral
- bacterial: s. pneumococcus, h. influenza, m. catarrhalis
Acute otitis media tx
- abx if bacterial
- myringotomy tubs: recurrent infections, hearing loss, speech delay
Acute otitis media complications
- acute: mastoiditis, suppurative labyrinthitis, brain abscess
- late: cholesteatoma
Mastoiditis presenation
- fever/toxicity
- pain, fluctuance over mastoid
- prominent pinna
- facial paralysis, vertigo, mental status changes
Mastoiditis tx
- intravenous abx
- CT scan
- surgery: mastoidectomy
Aural foreign body
- Presentation: hx, pain, drainage
- Ex: beads/toys, cotton, wax, insects
- Rx: removal, possible drops
Perforated TM presentation
- infectious following acute OM: fever, pain, otorrhea
- traumatic
- asymptomatic
Perforated TM tx
- infectious: drops, Abx
- Traumatic: observe
- asymptomatic
- hearing test
Perforated TM emergencies
- vertigo
- sensorineural hearing loss
- facial paralysis
Nasal foreign body
- presentation: hx, unilateral purulent rhinorrhea
- tx: remove
Epistaxis
- anterior: septal bleeding, self limited, more common
- posterior
Epistaxis causes
- trauma
- spontaneous
- associated factors: HTN, poor clotting, meds
Epistaxis tx
- supportive: saline nasal spray, humidification, ointment
- packing, cautery
- surgical
Acute sinusitis presentation and tx
- Presentation: rhinorrhea, facial/teeth pain, congestion
- Tx: abx, mucolytics, nasal steroids
Acute sinusitis complications
- orbit: preseptal cellulitis - cavernous sinus thrombosis
- intracranial: meningitis - brain abscess
Common throat emergencies
- peritonsillar abscess
- foreign body
- croup
- epiglottitis
- bronchiolitis
Causes of peritonsillar abscess
- bacterial: cellulitis to abscess
- strep, staph, anaerobes
Peritonsillar abscess presentation
- fever, sore throat, trismus, hot potato voice
- UNILATERAL symptoms (sore throat, ear pain)
- bulging tonsil, uvular deviation
Peritonsillar abscess tx
- drainage: I&D, quinsy tonsillectomy
- abx
- steroids to take swelling down (pt comfort)
Foreign body throat
- presentation: young child or eldery, witnessed chocking, asthma, pna, chronic cough
- tx: x-ray, fiberoptic laryngoscopy, angiogram if in tonsil bed, removal in OR
Epiglottitis presentation
- children age 2-6: fever, toxicity, sore throat, dysphagia, inspiratory stridor, rapid progression to airway obstruction
- Adults: less severe
Epiglottitis cause
- h. influenza type B (classical children)
- staph, strep, penumococci
Epiglottitis dx
- history or PE
- lateral neck x-ray
- fiberoptic laryngoscopy
Epiglottitis tx
- secure airway
- IV abx
- steroids
- children you need to take to OR stat
Laryngotracheobronchitis (croup) presentation
- children 6 months to 3 yrs
- winter
- milder URI sx
- barking cough, biphasic stridor
Croup cause
- viral: parainfluenza, adenovirus
- secondary bacterial infection
- swelling of subglottis
- low humidity
Croup dx
- H&P
- lateral and P-A x-rays: subglottic narrowing
Croup tx
- humidification, hydration, oxgyen
- RACEMIC EPINEPHRINE
- abx: only w/ secondary infection
- steroids
- airway control
Bronchiolitis presentation
- infants <18 months
- URI followed by respiratory distress
- cough, wheezing
Bronchiolitis cause
- respiratory syncitial virus
- parainfluenza 3
- other viruses
Bronchiolitis tx
- supportive care: oxygen, hydration
- Ribavirin
Head and Neck Trauma
- septal hematoma
- auricular hematoma (wrestlers)
- lacerations
- mandible fx
- clear rhinorrhea (unilateral)
