Nose MDT Flashcards
What is epistaxis?
Bleeding from nasal cavity
What is the most common form of epistaxis?
Unilateral, anterior nasal cavity
What is a rare finding that may cause epistaxis?
HTN
What labs should be done for epistaxis?
Coagulation tests
- Prothrombin time (PT)
- Activated partial thromboplastin time
(aPTT)
- Thrombin Time (TT)
Conservative treatment of epistaxis?
Direct pressure by compression of nares continuously for 15 minutes
What medications could you give for epistaxis?
Topical Nasal Decongestants
- Phenylephrine
- Afrin
Topical Anesthetic
- Lidocaine
What procedure can you perform for epistaxis?
Cautery with silver nitrate
How would you insert nasal packing for anterior epistaxis?
- Accordion like
- Placed in floor of nose
What medication should be given to prevent toxic shock syndrome from packing?
Cephalexin or Clindamycin
How long can packing stay before needing to give antibiotics?
5 days
What should be applied frequently to nasal packing?
NS to keep it moist
What are nasal polyps?
Benign nasal tumors arising from nasal mucosa
What is strongly associated with nasal polyps?
- Allergic rhinitis and food allergies
- asthma 20-50%
- ASA intolerance 8-26%
- Alcohol intolerance 50%
What radiological study should be done for nasal polyps?
CT of nose and paranasal sinuses
What medications can be given to patients with nasal polyps?
Topical Intranasal corticosteroids
- Flonase
- Nasonex
Short course oral corticosteroids
- Prednisone
How should massive nasal polyps be treated?
Surgically
What is the most frequently fractured bone in the body?
Nasal pyramid
Signs and sx of nasal trauma?
- Crepitus
- palpable step off of infraorbital rim
When would radiologic tests not be indicated for nasal trauma?
Uncomplicated nasal fractures
If you did a radiologic test for nasal trauma, what would it be?
CT
Treatment of simple nasal trauma?
Non specific
Acetaminophen
Nasal packing (usually unnecessary)
For extreme nasal trauma, what treatments should be done?
- Refer to emergency ENT (realignment, closed reduction)
- Surgery (septoplasty or rhinoplasty)
What causes seasonal allergic rhinitis?
Airborne allergens such as pollen
What causes perennial allergic rhinitis?
Dust mites, animal dander and mold
What is allergic rhinitis?
Inflammatory response in the nasal mucosa in response to specific allergen
Sx of rhinitis
- Clear rhinorrhea
- Turbinates pale or violaceous (venous engorgement
Intranasal corticosteroid medications for rhinitis?
Flonase or nasonex for 1-3months
How does the patient administer intranasal corticosteroid medications?
Hold bottle upwards, straight up with head tilted forward and bottle pointing towards ipsilateral ear when spraying
Antihistamine treatment of rhinitis?
- Loratadine (Claritin) 10mg PO daily
- Fexofenadine (Allegra) 60mg po BID or 120mg daily
What is sinusitis?
Inflammation of mucous membrane of one or more paranasal sinuses
Sx of sinusitis?
- Purulent yellow-green nasal discharge
- facial pain or pressure over sinuses
- Acute onset
How should you treat pain with sinusitis?
NSAIDS
What decongestants should be used with patients with sinusitis?
Pseudophedrine 30-60mg q 4hrs, max 240mg/day
Nasal Oxymetazoline (afrin) 1 or 2 sprays in each nostril q6-8hrs for up to 3 days
What antibiotics should be given for patients with bacterial sinusitis?
- Empiric
-Amoxicillin-Clavulanate 500mg/125mg PO TID or 875/125mg PO BID for 5-7days - Severe
- Amoxicillin-Clavulanate 2000mg/125 XR PO BID for 7-10 days
- PCN Allergy or hepatic impairment
- Doxycycline 100mg PO BID or 200mg PO daily for 5-7days
