HEENT Emergency Pharm

Question 1

Impetigo tx

Answer 1

• Topical mupirocin 2% TID

- oral bad for more diffuse infx

Question 2

Erysipelas tx

Answer 2

• beta lactam abx (96% effective)–> cephalosporin, carbapenems, monobactam

Question 3

Facial Cellulitis tx

Answer 3

• MIld: oral beta-lactam abx and 24 hour follow-up
• DM, severe infx, or failed outpt. Tx–> IV beta-lactam abx and inpatient hospitalization
• Purulent cellulitis: IV Vanc for MRSA coverage

Question 4

Mastication Abscess tx

Answer 4

• inpatient hospitalization
• airway stabilization if compromised
• IV abx and HEENT consult

Question 5

Mumps aka Viral Parotitis tx

Answer 5

Supportive

Question 6

Supportive parotitis tx

Answer 6

Mild: oral abx
- warm compresses, sour lemon drops, milk of duct, and hydration
Severe: failed outpt. Tx, DM, inability for PO–>
- IV abx and hospitalization

Question 7

Giant Cell Arteritis tx

Answer 7

High dose Steroids ASAP (do not wait for bc results)- can be IV/PO

• opth. Consult
• admit to hospital

Question 8

Bell’s Palsy tx

Answer 8

• steroids alone show benefits
• steroid + ART-> beneficial (not ART alone)
• neuro consult

Question 9

Bell’s Palsy ass. Exposure keratitis tx

Answer 9

• saline drops and eyelid taping

Question 10

Horner’s Syndrome tx

Answer 10

• depends on etiology

Question 11

Malignant Otitis External tx

Answer 11

• IV abx + pseudo coverage; inpatient bc life-threatening

- HEENT consult

Question 12

Mastoiditis tx

Answer 12

• IV abx, hospital admission, HEENT consult

Question 13

Lateral Sinus Thrombosis tx

Answer 13

• IV abx, hospital admission, HEENT consult

- Mastoidectomy

Question 14

Ear hematoma tx

Answer 14

• immediate incision and drainage of hematoma on ear + compressive wrapping may prevent “cauliflower ear”

Question 15

Ear laceration tx

Answer 15

• prophylactic abx
• perform a field block–> auricular field block; rq. 2-3 mL of anesthesia (Marcaine)
  — diamond shape pattern around ear
• irrigate and explore the wound
• consider plastic closure; only skin should be sutured
• ## pressure dressing

Question 16

When would you use abx in tx for temporal perforation?

Answer 16

• result of otitis media or significant evidence of debris

Question 17

Foreign body tx for alive object?

Answer 17

• viscous lidocaine to kill prior to removal
• only typically removed with forceps w/ direct visualization, Katz ear extractor, or hooked probe of suction catheter
• be careful w/ irrigation w/ organic material–> may cause to swell
• HEENT f/u with TM perf. Or failure to remove foreign body

Question 18

Though a minority of nosebleeds are posterior, if it is posterior it is likely from these two arteries:

Answer 18

• sphenopalatine artery

- posterior ethmoid