ENT Emergencies Lecture Powerpoint

Question 1

What comes first in an ENT emergency?

Answer 1

Airway

Question 2

Most common pediatric illness causing stridor (6-36 months)

Answer 2

Croup/acute laryngotracheobronchitis

Question 3

Croup/acute laryngotracheobronchitis presentation

Answer 3

Starts with URI symptoms, low grade fever, within 1-2 days develop hoarseness, barking cough, respiratory distress, symptoms resolve within 3-7 days but most can last 2 weeks

Question 4

Severe croup may be quiet due to…

Answer 4

….significant airway obstruction

Question 5

Westley croup score

Answer 5

A survey to score symptoms between 0-12 ranging severity with 12 being impending respiratory failure in a patient with croup

Question 6

Croup diagnosis (3)

Answer 6

• primarily clinical
• AP neck radiograph presenting with steeple sign
• CBC and other basic shit

Question 7

Croup treatment (mild and significant (3))

Answer 7

• Mild can be done at home with management
• significant respiratory distress will require oxygenation with ventilatory support (bag ventilation mask but potentially intubation (rare less than 2%)), single dose dexamethasone .6mg/kg oral, IM, or IV, or nebulized racemic epi

Question 8

Bacterial tracheitis

Answer 8

Uncommon cause of upper airway obstruction except in patients with tracheostomy or ET tube that is more common in the pediatric presentation, possible with croup patients that worsen or do not respond to typical treatments, majority require intubation as treatment, high grade fever unlike croup, no response to epi

Question 9

Only definitive way to diagnose bacterial tracheitis

Answer 9

Laryngotracheobroncoscopy

Question 10

Epiglottitis

Answer 10

Acute inflammation caused by bacterial infection typically of epiglottis and surrounding tissues, uncommon in US more common in populations lacking against Haemophilus influenza type B immunization, viruses do not typically cause but can predispose to bacterial infection, sees RAPID* symptom progression, often present with sore throat, dysphagia, hot potato voice, tripoding

Question 11

Classic clinical triad of epiglottitis

Answer 11

Drooling
Dysphagia
Distress

Question 12

Epiglottitis diagnostic studies (3)

Answer 12

• secure the airway first**
• nasopharyngoscopy/laryngoscopy
• thumb sign on x ray

Question 13

Epiglottitis treatment options (3)

Answer 13

• supplemental O2 unless agitates patient
• dexamethasone
• empiric antibiotics

Question 14

Most common deep neck infection in children, what about adults?

Answer 14

• tonsillar/pharyngeal infections

- dental infection/abscess

Question 15

Up to 1/2 of deep neck infections will lack…

Answer 15

….a identifiable source, and are often polymicrobial with at least 5 diff strains

Question 16

Gold standard diagnostic study for deep neck infections

Answer 16

CT scan of neck

Question 17

Deep neck infection treatment options (3)

Answer 17

• Airway first priority
• IV antibiotics
• I&D

Question 18

Peritonsillar abscess development

Answer 18

Acute pharyngitis/tonsilitis that sees worsening of the throat pain unilaterally

Question 19

Peritonsillar abscess diagnostic studies (2)

Answer 19

• CBC

- thin needle aspiration or I&D + culture after sedation

Question 20

Peritonsillar abscess treatment options (2)

Answer 20

• 2nd or 3rd gen cephalosporin

- Single dose IV dexamethasone

Question 21

Lemierre’s syndrome

Answer 21

Infectious thrombophlebitis of the internal jugular vein often following delayed/missed diagnosis of peritonsillar abscess that progresses resulting in persistent bacteremia

Question 22

Retropharyngeal abscess, and what happens if it isn’t treated?

Answer 22

Collection of pus in the posterior of the throat behind the posterior pharyngeal wall, if spreads to mediastinitis mortality is close to 50%

Question 23

Retropharyngeal abscess diagnostic studies (3)

Answer 23

• CBC
• I&D and culture
• CXR to rule out mediastinitis

Question 24

Retropharyngeal abscess treatment options (1)

Answer 24

-IV broad spectrum antibiotics

Question 25

Ludwig angina

Answer 25

Rapidly progressive gangrenous “woody” or brawny cellulitis of the sublingual and submaxillary spaces of the neck typically odontogenic in source from 2nd and 3rd molars most commonly, presents as bilateral submandibular swelling with elevated protruding tongue and airway compromise is a potential complication

Question 26

When you have a nose bleed should you lean forward or backward?

Answer 26

Forward

Question 27

Pain with EOMs is ___ until ruled out

Answer 27

Orbital cellulitis

Question 28

Treatment for periorbial vs orbital cellulitis

Answer 28

• Augmentin, clindamycin, doxy for periorbital

- 2nd or 3rd gen cephalosporin or vanco for orbital

Question 29

Orbital blowout fracture definition, treatment, and imaging study of choice

Answer 29

2nd most common midfacial fracture (2nd to nasal bone), often occurs with blow to orbit that can entrap muscle such as inferior rectus (upward gaze dysfunction) and medial rectus (lateral gaze dysfunction), treated with surgical decompression for entrapment, avoiding of sneezing, antibiotics, follow up with ophthalmology, CT of the orbits

Question 30

Dental trauma procedure

Answer 30

Normal adult has 32 teeth, broken may be associated with facial fractures, might aspirate, avulsed can be replaced so repalce as quick as possible don’t rinse off, can preserve in whole milk or balanced salt solution for up to 6 hours

Question 31

Procedures employed to remove foreign body (2)

Answer 31

Chest x ray followed by Rigid bronchoscopy