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Clin Med III > Exam 1 Emergency Med > Flashcards

Exam 1 Emergency Med Flashcards

1
Q

Cauliflower ear (aka wrestlers or boxers ear) is what? if left untreated, may result in what?

A

= hematoma of the pinna usually due to blunt trauma

  • left untreated may result in cartilage necrosis, chronic scarring and deformity
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2
Q

Describe a laceration of the pinna. What do you need to check for and what repair option is best?

A
  • bleed a lot
  • watch for hematomas, be sure no injury to internal ear
  • if laceration needs to be repaired, RUNNING SUTURE
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3
Q

What is often the cause of perichondritis (inflammation of the cartilage) and how does it present

A

Ear piercing, particularly to upper 1/3 of pinna can result in ear infection

Pain, erythema, warmth

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4
Q

What should you be aware of with perichondritis, specifically with the type and location of the infection?

A

upper 1/3 pinna cartilage is avascular, improper healing predisposes to PSEUDOMONAS and STAPH AUREUS infections that can spread rapidly and lead to deformity

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5
Q

If pt develops perichondritis infection (ie staph aureus or pseudomonas) what tx is recommended?

A

ABX and surgical debridement

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6
Q

What is MOE, pathogen, sx?

A

invasive infection involving temporal bone often seen in immunocompromised pt

Primary path: PSEUDOMONAS
*severe pain worse at night, purulent otorrhea, trismus, CN 7,8 palsies, edematous and erythematous ear canal with granulation tissue

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7
Q

Sx of MOE

A 
ear pain worse at night
purulent otorrhea
trismus
CN palsies
ear canal edematous and erythematous with granulation tissue
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8
Q

How do you dx MOE

A

CT

*need to r/o temporal bone involvement

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9
Q

How do you treat MOE

A

ENT referral

  • admission
  • IV abx: imipenem, cipro or ceftazidime
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10
Q

what is mastoiditis/what causes it? sx?

A

Extension of OE or AOM into mastoid air cells (suspect mastoiditis if slow resolution of OE or AOM sx)
*mastoid tenderness w/ edema and erythema, deep temporal pain

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11
Q

How do you dx mastoiditis

A

expect if slow resolution of OE or AOM

  • plain xray: density in mastoid air space (won’t see until 2 wk after onset)
  • CT BEST DX STUDY
  • tympanocentesis for fluid to culture
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12
Q

how do you treat mastoiditis

A 
Hospitalize
IV abx (Vancomycin: G+, or Nafcillin/Oxacillin: MSSA coverage, antistaph)

mastoidectomy required if complications, ie no response to IV abx

prognosis is good

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13
Q

Epistaxis causes

A 
most common: trauma
- FB
- iriitants (cigarette smoke)
Meds (aspirin, NSAIDS, anti-coag)
- digital trauma
- Hem disorders: hemophilia, leukemia, plt dysfunction, thrombocytopenia
- HTN
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14
Q

How should you initially treat epistaxis

A

have pt sit with head forward, direct pressure for 5 min

  • ensure hemodynamic stability, and airway patency
  • STOP bleeding, keep airway patent
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15
Q

what are silver nitrate sticks used for

A

cauterizing

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16
Q

where does epistaxis typ occur in children?

A

anteriorly on the nasal septum

  • branch of labial artery
  • kiesselbachs
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17
Q

Where does epistaxis typ occur in adults? elderly?

A

adults: Septum, posterior

Elderly: hard to id/control, branch of MAXILLARY a, posterior, more bleeding and systemic factors

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18
Q

How do you treat and anterior nose bleed

A

Topical vasoconstrictors

  • 2% neo-synephrine spray (a agonist)
  • 4% cocaine spray/sol on cotton pledgets

Cautery

  • chemical (silver nitrate)
  • hemostatic packing material: Gelfoam, Surgicel
  • Electrocautery (specialist)

Anterior packing
- petrolatum-impreg gauze packed in anterior nares with forceps, leave 48 hr

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19
Q

what topical vasoconstrictors are there for epistaxis tx

A

2% neo-synephrine spray (alpha agonist)

4% COCAINE spray/sol on cotton pledget

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20
Q

What types of cautery tx options are there for bleeds

A

chemical (silver nitrate)
Hemostatic packing material (Gelfoam or Surgicel)
Electrocautery (specialist)

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21
Q

What is anterior packing? how long is it left?

A

epistaxis tx option involving petrolatum-impreg gauze packed into the anterior nares with forceps; leave 48hr!!!

Or can use preformed nasal tampon

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22
Q

How do you treat Posterior nose bleeds

A

Vasoconstrictor: pledgets sat in 4-5% cocaine or 2% neo-synephrine

Anterior packing

Posterior packing: post pack + ant nares bilat; balloon cath (leave 2-5d), hospitalize if post pack or balloon catheter

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23
Q

how long is a balloon catheter left in

A

2-5 days

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24
Q

What are complications of posterior bleed tx

A

Septal hematoma, sinusitis, toxic shock syndrome

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25
Q

Nasal fx sx tx? concerns?

A

common injury usually from blunt trauma, usually associated epistaxis (eval fo septal hematoma)

  • non displace gen don’t need immediate intervention, ENT ref w/in 3-5d
  • blood with surrounding straw colored serous fluid, think other facial fx (ie cribiform plate), need urgent neurosurgical consult
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26
Q

how do you treat nasal fx surgically?

A

rhinoplasty

27
Q

Why do septal hematomas occur? sx?

A

seen after trauma, more freq in peds pt
sx: increase nasal obstruction, pain & tenderness
PE: soft, tender swelling

28
Q

Why is it so important to fix septal hematomas

A

if not fixed, septal hematoma is risk for avascular necrosis or saddle nose deformity

29
Q

How do you treat septal hematomas?

A

incision, drainage of hematoma to prevent avascular necrosis

*following drainage, pack nose & ABX

30
Q

When do you refer to ENT for FB removal

A

after 2 unsuccessful attempts (ie suction, irrigation, retrieval w/ alligator forceps)
*if remove one FB, look for a second

31
Q

What potentially life threatening complications can result from sinusitis and why?

A

result from extension of bacterial infection into orbital or intracranial spaces (can be viral or bacterial: H flue, strep pneumo, moraxella)

  1. Periorbital cellulitis
  2. Orbital cellulitis
  3. Cavernous sinus thrombosis
  4. Frontal osteomyelitis
32
Q

What is periorbital cellulitis? Cause?

A

infection confined to the eyelids (s. pneumo, s. aureus), may be complication of sinusitis or local disruption of skin (ddx: trauma, contact allergy, dacrocystitis)

33
Q

s/sx of Periorbital Cellulitis, PE assessment?

A

unilateraly periorbital edema with erythema, tenderness, fever

PE: assess visual acuity, EOM
*vision loss, diplopia, proptosis = intraorbital involvement consistent with ORBITAL cellulitis

34
Q

on eye PE, if vision loss, diplopia, and proptosis, what should we fear

A

orbital cellulitis

35
Q

What is the most helpful study for dx of periorbital /orbital cellulitis

A

CT scan will distinguish bw perioorbital and orbital cellulitis

36
Q

how do you treat periorbital cellulitis

A

hospitalize anyone who is febrile and appears acutely ill
IV ABX
consult ophthalmologist and/or ENT
*prognosis good if tx started early

37
Q

What is orbital cellulitis and what can it cause

A

TRUE EMERGENCY; can lead to vision loss, meningitis, cavernous sinus thrombosis, frontal abscess
*periorbital edema, erythema, proptosis, chemosis (inflammation of conjunctiva), impaired EOM, vision loss, diplopia

38
Q

How should you treat orbital cellulitis

A

true emergency
need to admit for IV abx
NAFCILLIN + CEFTRIAXONE + METRO IV

39
Q

What is cavernous sinus thrombosis? Cause? sx?

A

acute dev of sx following infection (orbital cellulitis)

  • severe unilateral, retro-orbital HA
  • bilateral proptosis
  • ophthalmoplegia
  • vision loss
  • sensory dysfunction (hypo/hyperesthesia of CN V, 1st branch, ophthalmic branch)
    • very sensitive or not sensitive at all
40
Q

Cavernous sinus thrombosis PE findings

A
  • febrile, toxic appearing pt
  • periorbital edema
  • CN dysfunction (III, IV, VI)
  • Papilledema (late): blurring of optic disc margins due to increased intracranial pressure
  • Need urgent heat CT, IV abx (vancomycin, ceftriaxone)
41
Q

how should you treat cavernous sinus thrombosis

A

Need urgent head CT

IV abx: Vancomycin, Ceftriaxone (Rocephin IM)

42
Q

Frontal Osteomyelitis.. what is it? cause?

A

aka pott’s puffy tumor (infection of frontal bone –> progressive swelling of forehead) due to complication associated with frontal sinusitis

*most commonly S. aureus and anaerobes

43
Q

Pt recently was dx with frontal sinusitis and now present to the office with HA and progressive swelling of the forehead.. what is your suspected ddx? how do you confirm? tx?

A

suspect frontal osteomyelitis

dx: CT or MRI is dx
tx: drain abscess, debridement of infected bone, IV Abx Vanco or Nafcillin (G+ and some G-)

44
Q

PE findings, Cavernous Sinus thrombosis.. actions to take?

A

febrile, toxic appearance, CN dysfunction (III, IV, VI), periorbital edema, papilledema (late)

*need urgent heat CT, IV Abx (vanco, ceftriaxone)

45
Q

Cause frontal osteomyelitis

A

complication of frontal sinusitis (often S aureus and anaerobes)

46
Q

Cause of tongue laceration? risks? tx?

A

usually related to injury (teeth)

  • great potential for infection and hematoma
    tx: usually not sutured unless more than 1/3 width of tongue or tip of tongue involved (use absorbable sutures and give abx)
47
Q

Cause, outcomes, tx puncture wounds in mouth

A

common, rarely serious, often due to running with something in mouth, almost always small

  • bleeding resolves spontaneously, start abx if necessary
  • rinse with warm water after every meal, topical anesthesia for pain control (Orabase dental paste or solution or maalow and liquid benadryl)
48
Q

Topical anesthesia for puncture wounds?

A

for pain control
Orabase dental paste to prevent irritation
Solution of maalox and liquid benadryl soluation 1:1

49
Q

What typically presents with uvula displacement

A

Peritonsillar abscess (need to drain but watch out for carotid artery located behind abscess, give abx)

50
Q

Ludwigs Angina: what is it? cause?

A

infection involving the submandibular space; 85% result of dental infection but can also see with peritonsillar abscess, oral malignancy or mandibular fx

rapidly progressive infection associated with neck swelling, tongue protrusion, pain; also fever, malaise, trismus and halitosis

51
Q

Ludwigs angina can be seen with what other conditions

A

dental infection
peritonsillar abscess
oral malignancy
mandibular fx

52
Q

common pathogens of Ludwigs angina infection of submandibular space?

A

Streptococcus
staphylococcus,
bacteroides

53
Q

Spread of Ludwigs Angina infection of submandibular space can

A

compromise oral cavity, airway, deep neck spaces

54
Q

Sx of Ludwigs angina include

A 
neck swelling
tongue protrusion
pain
fever, malaise
trismus
halitosis
55
Q

Tx of ludwigs angina

A

ENT consult for potential airway compromise, surgical debridement, IV ABX

56
Q

What is a peritonsillar abscess and sx?

A

Most common abscess of the head
sx: fever, severe sore throat, drooling, odynophagia, otalgia, “hot potato” voice

signs: trismus, UNILATERAL erythema, swelling, UVULA DISPLACEMENT

57
Q

keep features peritonsillar abscess

A

UNILATERAL erythema, uvula displacement

58
Q

tx for peritonsillar abscess

A

drain abscess, abx

59
Q

What is sialoadenitis? cause?

A

inflammation of any salivary glands (parotid, submandibular, sublingual)
*Viral or bacterial etiology
*suppurative most commonly caused by Staph aureus
Obstructive from stone or calculus in salivary gland or duct

60
Q

Who typically has sialoadenitis

A

elderly, DM, poor oral hygiene, dehydration

61
Q

sx of Sialoadenitis (inflam of salivary gland)

A

enlarged swollen, painful mass
with stone, may complain of xerostomia (dry mouth); pain worse during mealtime
VIRAL = BIlateral
bacterial = UNilateral

62
Q

other ddx of sialoadenitis?

A

also concerned LAD
strep throat
Mono
wt loss and painful cervical LAD worry about Hodgkins Lymphoma

63
Q

How do you treat Sialoadenitis?

A

if supporative (usually due to S aureus pathogen) –> anx such as nafcillin

  • rehydration, proper oral hygiene
  • surg irrigation, drainage
  • if obstructive etiology: most stones will pass spontaneously; lozenges to stimulate salivary secretion
64
Q

what lab value will be elevated with Sialoadenitis

A

serum amylase (bc inflammation of parotid gland)

Clin Med III (5 decks)

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