Nose, Mouth and Throat Flashcards
Epistaxis
Symptom! What is the cause? Topical vasoconstrictor Saturate cotton with vasoconstrictor Silver nitrate-burns for 30 minutes ER referral May need rhino rocket
Rhinitis
Symptoms and Treatments
Generally allergic in nature
Symptoms – sneezing, itching, rhinorrhea, congestions, headache, earache, tearing, fatigue, red eyes
Treatment
Control of allergens – avoidance, dust covers, no rugs, etc.
Allergy shots – through allergist following testing
Intranasal steroids and oral antihistamines
Decongestants, singular
Pale boggy turbinates
Clear thin watery nasal discharge
1st Line-Nasal steroids
2nd Line- Nasal steroids and Antihistamine-works well for wet and drippy patient!
3rd Line-Nasal steroids, Antihistamine and Decongestant-HTN
4th Line- Nasal steroids, Antihistamine, Decongestant and Leukotriene blockers (singular)
5th Line- Nasal steroids, Antihistamine, Decongestant, Leukotriene blockers and Topical cromolyn- mast cell stabilizer as prophylactic
Acute rhinosinusitis
Inflammation lasting >4 weeks
Allergens, irritants and or infections: viral, fungal, or bacterial
Chronic rhinosinusitis
Inflammation lasting >12 weeks
Asthma, cystic fibrosis, immunocompromised state, ciliary dyskinesia
Acute bacterial rhinosinusitis- sinusitis
Secondary bacterial infection Less than 2% viral infections 10 days Clinical presentation beyond 10 days after onset of URI or worsening of symptoms within 10 days (double worsening) Nasal congestion, Facial pain, post nasal drip, headache, fever, yellow or green nasal discharge Pain worse in am Pain worse when bends over at waist Dental pain Sinus tenderness with percussion Sinus x-rays not recommended Maxillary sinuses Pain and palpated tenderness over cheeks and upper teeth Frontal sinuses Pain and palpated tenderness over eyebrows Sphenoid sinuses Pain to back of head Ethmoid sinuses Pain behind and or between eyes
Distinguish Acute bacterial rhinosinusitis from Acute rhinosinusitis
Confirm a clinical diagnosis of CRS with objective documentation of Sino nasal inflammation Anterior rhinoscopy Nasal endoscopy Computed tomography NO XRAYS!
Risk for antibiotic resistance
Age <2 or >65 Daycare Prior antibiotics in previous 4 weeks Prior hospitalization <5 days Comorbidities Immunocompromised
Sinusitis Antibiotics
Mild and No ABX in past 4-6 weeks
Amoxil, amox/clavulanate, cefpodoxime, cefuroxime
Moderate symptoms, No improvement in 72 hours, ABX in past 4-6 weeks
High dose Augmentin
Resp Quinolone
ABX in past 90 days…BL may have a beta lactamase producer left behind or viral!
Pharyngitis
Viruses are responsible for most cases of acute pharyngitis.
Group A beta-hemolytic streptococcus is the most common bacterial cause, accounting for 15 to 30 percent of cases in children and 5 to 10 percent of cases in adults.
It is the only common cause for which antimicrobial therapy is clearly indicated.
Pain worse when swallows
Oral candidiasis
Fungal Infection
White lesions on tongue, buccal mucosa, and palate with redness
Risk factors: immunocompromise, steroid use, poor oral hygiene, dentures, smoking, antibiotic use, vitamin deficiency
Treatment
Nystatin suspension (especially in children)
Infants 1 ml each side of mouth four times a day, use for 48 hours after symptoms resolve
Clotrimazole troche 10 mg five times a day for 1-2 weeks
May need oral fluconazole for severe 100-200 mg daily x 1-2 weeks
Tonsillitis
Inflammation of tonsils
Symptoms – fever, sore throat, foul breath, dysphagia, cervical lymph nodes
May lead to peritonsillar abscess (drooling, trismus, change in voice)
May need CT with contrast to diagnose & I & D to treat (needs referral)
Treatment
Supportive – fluids, rest, pain control
Steroids – for severe symptoms, Dexamethasone or prednisone
ABX – PCN or Amox x 10 days, OR Clindamycin/Cephalosporin x 10 days
Oral Health in Adults
Brush twice daily Regular flossing Visit dentist every 6 months Screening for oral cancer Avoid tobacco products – smoking, chewing, etc. Limit alcohol Drink plenty of water to avoid dry mouth Avoid excessive sugar intake
Dental Abscess
Abscess around teeth
Symptoms – pain, swelling, drainage, fever, etc.
Concerning symptoms – trismus (can’t open mouth), dysphagia, difficulty breathing, neck swelling
Treatment – I & D if able, pain control, ABX, soft diet, refer to dentist
ABX – Pen VK 500 mg QID x 10 days, Clindamycin 300 mg QID x 10 days
Complications – osteomyelitis, cavernous sinus thrombosis, Ludwig’s angina, large abscess, necrotizing fasciitis
Dental Fracture
Acute – from an injury or Chronic – poor dentition (bit down on something) Different types depending on severity of fracture If acute – get dental x-rays if available, otherwise CT facial bones Type I (enamel only) – smooth rough edges and refer Type II (down to dentin) – cover with Dycal and cover with foil – refer & ABX Type III (down to pulp) – cover with Dycal and cover with foil – refer ASAP & ABX Other types may require splinting
Avulsed Tooth
If dental trauma causes tooth to become avulsed:
Do not touch root or clean tooth – handle only by crown
Attempt re-implantation in field if possible
Put tooth in the following:
Hanks solution
Milk (3 hours)
Saline
Saliva – not ideal
Water (least ideal)
