ENT emergencies Flashcards
Severe tonsillitis
With severe sore throat and dehydration –> admit for IV fluids and Abx
Get Blood tests - FBC (neutrophil count), U&Es, CRP
Mx:
Sit patient up - ABC
FBC, U&Es, monospot
IV acccess+ fluids, IV aBx
If drinking or eating –> oral Abx
Adjuvant steroids if quinsy
Epiglottitis
Do not touch the airway
Intubation
Sterois
IV Abx
Otalgia
Causes can be divided into otalgic cause and non-otalgic cause (referred pain)
Need to examine the throat too
Referred pain - through the same innervation of the ear as other places e.g. nasopharynx, TMJ, dental, otnsils, oropharnyx, hypopharyngx,
Ear pain + dysphagia –> possible cancer (red flag)
Acute otitis externa if severe - ear wick then apply ear drops
ACute otitis externa
Malignant otitis externa
usually in immunocompromised patients e.g. diabetics (esp if uncontrolled), long term steorids, chemoradiotherapy, renal failure
Check blood glucose!
Severe otalgia and otrrhoea
Not responsive to ear drops
Pain worse at night (nocturnal)
Raidartes to TMJ
Facial palsy
Pseudomonas is usually the culprit! That’s why we need to give ciprofloxacin
Biopsy to rule out malignancy
Pinna haematoma
Ear infection (piercing) causing perichondritis –> give ciprofloxacin (good penetration to cartilage)
Mastoiditis
Acute sinusitis
oedematous eyelids
No pain on eye movement
No visual changes
Massive opacification in maxillary sinus –> acute sinusitis
The sinusitis spreads across the ethmoid wall (super thin) into the orbit
Orbital complications of acute sinusitis:
Group 1 - pre-septal cellulitis
Group 2 - orbital cellulitis
Group 3 - subperiosteal abscess
Group 4 - orbital abscess
Group 5 - carvernous sinus thrombosis
Orbital cellulitis
Mx
Mx:
Check Mx guideline for the algorithm
Need CT scan to assess the severity
Lithium battery or organic things e.g. peanut
REMOVE RIGHT AWAY (EVEN IF IT’s MIDNIGHT)
CORROSIVE -> ear drum perforation, septal perforation
TRacheal FB –>
Inorganic things –> can leave it in the ear for 1 yr
