HNT Emergencies Flashcards
Pathogen in viral parotitis
Mumps
Clinical features of viral parotitis
Fever, Malaise, Headache, anorexia
Myalgia/arthralgia
Bilateral enlargement, tense and painful glands
ABSENCE OF PUS
Epididymo-orchitis MC extra salivary glands
Viral parotitis
Treatment
Mainly supportive
Can be prevented with vaccine
Suppurative parotitis
Risk factors
Diminished salivary flow
Advanced age
Dehydration
Diuretics
Common pathogens suggested in Suppurative parotitis
Staph aureus, strep pyrogens
Bactericides and fusobacteirum (anaerobes)
Suppurative parotitis
Clinical features
Rapid onset, FEVER, TRISMUS, erythema, pain over parotid gland
PUS is not able to be expressed
Management of Suppurative parotitis
Outpatient treatment - warm compress, milking of duct, lemon drops, oral ABx
Severe - IV abx
Clinical features of temporal arteritis
Ischemic optic neuropathy
UNILATERAL + vision changes
Jaw claudication, decreased temporal pulse, TIA/stroke symptoms
Sed rate/CRP elevated
temporal arteritis management
High dose systemic steroids , Opthalmologist consult, admission to hospital
Horner’s Syndrome
Classic triad
Ipsilateral ptosis (flaccid eyelid)
Ipsilateral mitosis (pupil constriction)
Ipsilateral anhydrousus (absence of sweat)
Horner’s syndrome
Cause
Impaired sympathetic nerve
CVA, tumors, internal carotid dissection, tumors, trauma
Papilledema
Bilateral via intracranial pressure
Inflammatory pupillitis
Unilateral papilledema
Caused by MS
Malignant Otitis externa
Pathophys
Simple otitis externa that spreads to deeper tissues and causes granulation of external canal and infects cartilage, periosteum, soft tissue and bone
Malignant Otitis externa
Pathogens
90% pseudomonas aeruginosa (MRSA 10%)
Malignant Otitis externa
People at risk
Elderly
Immunocompromised
Diabetics
Malignant Otitis externa
Diagnosis
Must have high suspicion
EXTREME pain
Green/gray discharge
Tissue granulation in the canal
CT scan the head (w/contrast) to determine bony erosion
Malignant Otitis externa
Treatment
IV Abx + pseudomonas coverage
ENT consult
Mastoiditis
Clinical features
Infection that spreads from middle ear to mastoid air cells of skull
Otalgia, fever, and post auricular erythema, swelling and tenderness
Mastoiditis
Management
IV Abx, hospital admission, HEENT consult
Lateral sinus thrombosis
Cause
Extension of mastoiditis that occuleds lateral venous sinuses and blocks sinus drainage
Infection goes right into brain
Lateral sinus thrombosis
Clinical features
Fever, HA
6th cranial nerve palsy (inability to abduct eye)
Convergent strabismus and complaint of diplopia
Lateral sinus thrombosis
Dx and tx
Contrast CT
IV abx, HEENT consult, likely mastoidectomy
TM perforation
Cause
Otitis media
Foreign body
Blast injury
Will result in CONDUCTIVE HEARING LOSS
TM perforation
Management
Typically supportive
No ear drops or water until healed
Basilar skull fracture
Look for (4)
Mc thru temporal bone
Otorrhea from external or auditory canal (clear/bloody drainage)
Hemotympanum (blood behind TM)
Battle sign (postauricular hematoma, develops following injuries)
Raccoon eyes
Correct management strategies for ear foreign body
Immobilize insects with lidocaine
Can be removed with forceps, Katz ear extractor, suction catheter
Irrigation possible if not organic material
Epistaxis anatomical locations
Anterior (90%) due to kiesselbach’s plexus
Posterior due to posterior ethmoid or sphenopalatine arteries
Risk factors of epistaxis
Younger adults are typically minor, elderly tend to have worse
Anticoagulants increase risk
Possible complications of posterior epistaxis
Usually arterial pattern and more profuse posterior
Aspiration of blood or airway compromise
Etiology of epistaxis
Local trauma (picking*, foreign body,facial trauma, nasal surgery)
Environmental
Coaguloptahies
Drugs
Other (congenital weakness, septum anomalies, tumors, HTN)
Epistaxis management
STARTING
Ask if patient is on blood thinner
Keep calm and get them on IV
Have blow nose to clear out the space
Use light to find source of bleeding
Anterior epistaxis management
Direct pressure on fleshy for 20 min and observe for 30 min.
Discharge and recommend daily lubrication
May insert cotton pledget w/local vasoconstriction
Posterior epistaxis management
Dilate and grab rhino rocket
Insert and inflate nose
Observe for 30 min
Septal hematoma
Pathology
Direct nasal trauma
Causes torn vessels and collection of perichondrium/septal cartridges
Anterior nasal septum is site
septal hematoma complications
Abscess formation
Septal perforation
Saddle nose deformities
septal hematoma
Clinical features
Signs of trauma (not always)
Medical nasal passage is asymmetric
Cribriform plate fracture
Clinical features
CSF leak
Double ring sign (blood + CSF on test)
Drainage of clear rhinorrhea after trauma to mid face
Cribriform plate fracture management
Hospital admit + neuro consult
Head elevation and lumbar drain
Prophylactic ABx and surgical repair
Epidemiology of nasal foreign bodies
Pediatrics
2-5
Nasal foreign body
Clinical features
Unilateral rhinorrhea +/- blood or odor
Nasal foreign body
Management
Katz nasal extractor, alligator forcepts
If nec. Call ENT and maybe anesthesia
Facial layers of the neck
Superficial (platysma)
Middle facial layer (pretrachial and retropharyngeal layer)
Deep cervical fascia layer (prevertebral)
Major risk of facial injuries
Bleeding and inflammation - can cause airway compromise
High risk clinical features in fascial injuries
Vocal change
Drooling
Stridor at rest
Persistent tachycardia
Platysma space infection
Etiologies
Ludwig angina
Prolonged tracheostomy infection on ant. Surface
Pre-tracheae middle space infection etiologies
Perforation of anterior esophageal wall
Contiguous extension from retropharyngeal space infection i
Prolonged tracheostomy
Pre vertebral
Deep space infections
Originate from cervical spine infection (discitis or vertebral osteomyelitis)
Mc pathogens staph aureus and MRSA
Peritonsillar abscess (PTA)
Risk factors
Prior PTA
Smoking
Peridontal dz
Chronic tonsillitis
Repeat abx
PTA clinical features
Appear ill, fever, malaise
Sore throat, displaced uvula, odonophagia
Muffled voice, drooling
PTA management
Aspiration with 18/20 gage needle (dont go more than 1cm in - carotid)
HEENT specialist
Clindamycin
Vanco if CA MRSA is suspected
Retropharyngeal abscess
Risk factors
Intraoral procedures
Trauma
Foreign bodies (i.e. fishbone)
Extension of dental infection
Clinical features retropharyngeal abscess
Sore threat
Cervical lymphadenopathy
Stridor
Neck pain
Poor intake
Retropharyngeal v. PTA
PTA is up top, displaced uvula
RPA is down lower, gold standard dx is CT scan w/IV contrast
Sore NECK
Anterior mandible dislocation
History of opening mouth extreme
Pain anterior to Travis
Clinical dx
Reduction to treat
Lateral, posterior, superior dislocations
Requires SIGNIFICANT trauma
Dx with CT scan
Keep patient NPO and get surgical consult
Severe facial fractures are associated with …
Injuries to brain, orbits, cervical spine, and lungs
History if someone with facial trauma
Can you tell me name? What happened?
Does neck hurt?
Lose consciousness?
Numbness in face?
Bite feel normal?
Le Forte fracture
Fracture that occurs when the internal bone structures are removed from the skull
Inspection of facial trauma
Le Forte
In Le Forte II - lateral, fish face
Le Forte III - donkey face, frontal
Palpating face (rock hard pals with one hand, stabilize in other)
Physical exam finding
Basilar skull fracture
Raccoon eyes
Battle signs
Hematypanum
CSF leak
Facial trauma eye
Examine
Document acuity
Examine eyes thoroughly
Evaluate for orbital fractures
Asses pupil
Le Fort I
Only fracture in hard palate and teeth
Le Fort II
Movement of upper teeth, hard palate and nose
Dish face deformity
Le forte III
Entire face shifts with globes held in place by optic nerve
Donkey face
Posterior triangle borders
Posterior sternocleidomastoid
Anterior border of trapezius
Middle third of clavicle
Anterior triangle borders
Border of mandible
Anterior midline of neck
Anterior border of sternocleidomastiod
Components of anterior triangle
Carotid a. Internal jugular v. Vagus n. Thyroid gland Larynx Trachea Esophagus
Posterior triangle components
Few vitals
Subclavian a. And brachial plexus at base
Zones of anterior triangle
Zone 1 (5)
Clavicle to cricoid cartilage
Vertebral and carotid Major thoracic vessels Apex of lungs Esophagus Trachea Spinal cord
Zones of anterior triangle
Zone II
(5)
Inferior margin of carotid cartilage to angle of mandible
Vertebral and carotid a. Jugular vein Esophagus Trachea Spinal cord
Zones of anterior triangle
Zone III (3)
Angle of mandible to base of skull
Vertebral and carotid a.
Pharynx
Spinal cord
Etiologies of carotid a. neck injuries
- HyperEXTENSION that causes compression against transverse process
- HyperFLEXION that results in compression b/t mandible and c-spine
- Direct blows
- Intraoial injuries
- Basilar skull fracture = tearing of intracranial portion of Carotid
Results of vascular neck injuries
Vertebral artery dissection
Subintimal hematoma
Complete thrombotic occlusion
Clinical features of
Vascular neck injuries
Asymptomatic, intermittent, or delayed
Headache, neck pain
Ipsilateral facial paralysis
Horner Syndrome
How are vascular neck injuries diagnosed?
CTA of head and neck
