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Surgical Jobs > ENT Hot-desk Management > Flashcards

ENT Hot-desk Management Flashcards

1
Q

Acute maxillary sinusitis:

Systemically Well

A

Home
Nasal steroids (fluticasone/beclametasone)
+/- Oral co-amoxiclav 625mg TDS

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2
Q

Acute maxillary sinusitis:

Unwell

A
  1. EXCLUDE PERIORBITAL CELLULITIS
  2. Admit- IV Co-Amoxiclav 1.2g TDS
  3. Washout
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3
Q

Peri-orbital cellulitis

A

IMMEDIATE ESCALATION TO SpR
Joint care with Opthalmology
IV Co-amoxiclav

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4
Q

Acute Ethmoiditis

A 
IMMEDIATE ESCALATION TO SpR
Ophthalmology review 
CT head
IV Cefotaxime
? Book for washout
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5
Q

Tonsillitis

A

Consider glandular fever- monospot test
Admit if: immunocomprimised, diabetic, SOB, stridorlous or septic.
If not- Initiate Portsmouth protocol

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6
Q

Tonsillitis- Portsmouth protocol

Which patient groups trial medical managment?

A
  1. Those who can swallow and do not have disproportionate pain
  2. Those struggling to swallow or in pain WITH NORMAL LARYNGOSCOPY
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7
Q

Tonsillitis- Portsmouth protocol

What is Trial management

A 
IV Benzylpenecillin 1.2g (or 500mg Clary if allergy) 
IV Dex 4mg 
IV Paracetamol 1g
Diclofenac 
Difflam mouthwash
IVI

Reassess after 2 hours.

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8
Q

Tonsillitis- Portsmouth protocol

Reassessment criteria.

A

Can they swallow? Are they stable?

YES: Discharge with 7/7 Penicillin V / Clarithromycin 500mg, analgesia and info sheet

NO: Admit.

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9
Q

Quinsy

A

ADMIT
Local Anesthetic
Aspiration with white needle
IV Co-amox/ Clari

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10
Q

Ludwig’s Angina

A

ADMIT
Max Fax review
Airway stablisation ?emergency Trache
IVI
IV Gent (1mg/kg TDS), Co-Amox (1.2g TDS) and Metro (500mg TDS)
Dex 8mg
Lateral soft tissue neck XRay + AP/Lateral CXR

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11
Q

Retrophayngeal abscess

A

ADMIT
Lateral soft tissue Xray neck
Airway management
IV access, bloods and cultures

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12
Q

Epi/Supra glottitis

A 
ADMIT
Alert CEPOD
Nasendoscopy in adults only
Cefotaxime 1g BD (50mg/kg if <11yrs)
Dexamethosone 8mg (150micrograms/kg BD in children)
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13
Q

Anaphylaxis / Hereditary Angioedema

A 
ADMIT
0.5ml 1:1000 adrenaline IM
200mg Hydrocortisone IV
4mg Piriton
IVI 
O2 
Airway support
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14
Q

Post-tonsilectomy bleed

A 
ADMIT 
Observations 
IVI + IV ?Abx? 
Hydrogen peroxide 3% mouthwash
Adrenaline soaked gauze 
Silver nitrate cautery 
Tranexamic Acid
- Alert CEPOD +/- major hemorrhage protocol
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15
Q

Epistaxis

A

Check Airway
Check haemodynamics
1. Compression 15mins
2. Lidocaine plug + compression
3. Examination
4. Cautery of visible bleeding points
#IF STILL BLEEDING AT THIS POINT WILL NEED ADMISSION #
5. Insert Pack
6. Bolster with swab
7. Tranexamic acid
8. IV Access and BLoods including G&S
#IF STILL BLEEDING AT THIS POINT ALERT SpR#
9. Bilateral or Posterior packing
10. Foley Catheter
#IF STILL BLEEDING ALERT CEPOD- FOR LIGATION#

Naseptin

If >24hrs packed PO Abx

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16
Q

Foreign Body in Nose

A

Is it Caustic or alive?
NO- Emergency clinic r/v
YES- Attempt removal immediately

  1. “Mothers kiss”
  2. Otravine Nasal spray + 2nd “Mothers Kiss”
  3. Attempted manual removal- suction, tilleys or ear hook
  4. If unsuccesful list for theatre
17
Q

Foreign Body in Ear

A

Is it Caustic or alive?
NO- Emergency clinic r/v
YES- Attempt removal immediately (Poor oil in to kill living FBs)

  1. Suction.
  2. Crocodile Forceps
  3. Wax Hook

If unsuccessful list for theater

18
Q

Foreign Body Sensation in Throat

A

Protect airway
Inspect oropharynx.
If visible attempt manual removal under local anesthetic
Lateral Soft x-ray of neck
Flexible Nasal Endoscopy
Examine to exclude perforation.
If nothing identified- D/C to review in 1/52

19
Q

Confirmed Foreign body in throat

A

IS it sharp/ hard or caustic? Is It compromising airway?
YES: List for theater
NO: Attempt conservative management.

  1. Buscopan 20mg x 2 (30 mins apart)
  2. Full fat coke
  3. Analgesia
  4. NMB (?sips) overnight
  5. Endoscopy to push down/ remove Mane
20
Q

?Perforation from FB in throat

A 
Look for: 
-Chest/ shoulder or back pain
-Surgical Emphysema 
-Fever
If present= CT, antibiotics and list for theater
21
Q

Sudden (<3 days) Hearing loss

A

CONSIDER CENTRAL CAUSE

  1. Audiogram
  2. 7/7 PO Prednisolone 60mg + PPI Cover
  3. Bloods- including autoimmune screen
  4. Medication review
  5. Repeat Audogram in 2/52
  6. O/P MRI
22
Q

Snoring

NEVER URGENT

A

Perform Epworth scoring:
<10 Get GP to refer to dentist
>10 refer to sleep nurse

23
Q

Stridor unkown cause

A

CALL SpR IMMEDIATELY
IV Hydrocortisone 8mg
Oxygen
Nasendoscopy

24
Q

Auricular Haematoma

A
  1. Attempt needle aspiration
  2. Incision and evacuation on lateral pinna.
  3. Pressurised betadine dressing + sutures
  4. 5/7 Flucloxocillin 500mg QDS
25
Q

Traumatic TM perforation

A

EXCLUDE PERI-LYMPH LEAK

  1. Prophylactic amoxicillin 500mg TDS 5/7
  2. Water precautions
  3. O/P Audiogram 2 weeks
26
Q

Fractured Nose

A

EXCLUDE SEPTAL HAEMATOMA

SH NOT present: O/P review in 10 days
SH PRESENT: Admit, List for theater, antibiotics.

27
Q

Bells Palsy

A

Exclude ALL other causes of CN VII Palsy
Steroids 1/7
Eye Care
Review in clinic in 1/12

28
Q

Otitis Media

A

CHECK FOR NEUROLOGICAL COMPLICATIONS
Oral Amoxicillin
Topical Abx
Simple analgesia

29
Q

Otitis Externa

A 
Swab C&amp;S
Microsuction debris
Insert popewick if necessary 
Topical antibiotics + Steroids (Gent if TM visualised, Cipro if not 14/7)
PO antibiotics if systemically unwell.

Surgical Jobs (3 decks)

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