Trans 27 ENT Emergencies Flashcards
Secondary complications of foreign body in ear.
Infection and mucosal erosion
When not to use irrigation in foreign body?
If organic foreign body
Foreign body in the nose symptoms?
Purulent unilateral nasal discharge
• Usually lodge on the floor of anterior or middle third
Management foreign body in the nose?
Good visualization: head lamp & nasal speculum
• Alligator forceps should be used to remove cloth, cotton, or
paper
• Other hard FB are more easily grasped using bayonet
forceps
Most common site of lodgement of foreign body
Anatomicconstrictions:cricopharyngeus-MC
3 anatomic constrictions which are:
Cricopharyngeus, aortic notch, hiatus. But most FB will
lodge here in the cricopharyngeus, the opening of the esophagus.
3 stages of symptoms of foreign body in the esophagus
• First stage
o Violentparoxysmsofcoughingorgagging
When they swallow, they’ll try to expel it. And if it is not
expelled, there will be a stage where you don’t feel
anything, it’s just there • Second stage
o Symptomless interval
Might not be present in most cases. When the FB is in the
esophagus, they will not be able to drink, they won’t eat
because they will vomit it out • Third stage
o Complications
True OR false Esophageal FBs require more urgent treatment than those in the tracheobronchial tree
True
Tree or false FBs that have reached the stomach will pass through the remainder of the GIT without difficulty
true
In complete obstruction, the FB must be disimpacted or alternate airway established in
4 minutes
you go behind the patient, upward thrust with your thumb. Goal is to put abdominal pressure, which will transmit into the thoracic cage and remove FB. Once you do this without success and your patient is unconscious, then start doing your CPR
heimlich maneuver
step by step what to do if there is airway obstruction?
- Heimlich meneuver- airway compromise Abdominal thrust
- Mouth-to-mouth resuscitation 3. Cricothyrotomy
- Tracheostomy
how to know if the FB is in the larynx or trachea?
FB LODGED IN LARYNX
• Discomfort, hoarseness, cough, dysnea FB LODGED IN TRACHEA
• Audible slap, palpable thud
how to know if the FB is in the larynx or in the trachea?
FB LODGED IN LARYNX
• Discomfort, hoarseness, cough, dysnea FB LODGED IN TRACHEA
• Audible slap, palpable thud
A foreign body lodged in the tracheobronchial tree, not totally occluding the airway, is not as great an emergency as one that is lodged in the esophagus unless:
o It is sharp
o Uncooked
o Dehydrated
which can absorb fluids and swell within the lumen
Aggressive and potentially life-threatening infection of the soft tissues of the external ear and surrounding structures, quickly spreading to involve the periosteum and bone of the skull base
malignant otitis externa
hallmark finding in malignant otitis externa?
Granulation tissue on floor of the ear canal at the bony-cartilaginous junction
with pain and high fever
microbio associated with mlignant otitis externa?
Pseudomonasaeruginosa(95%) o Fungus (A. Fumigatus, A. Flavus, A. Niger)
predisposing factors in malignant otitis externa
Diabetesmellitus
o Immune-compromisedstatus
CLINICAL FEATURES • Long-standing otalgia (worst at night) • Otorrhea • Cranial nerve palsy • Headaches, fever • Neck stiffness • Altered levels of consciousness
these are features of what?
malignant otitis externa
medical tx for early and advanced stages of malignant otitis externa?
Early infections- oral fluoroquinolone
o Advancedstages-parenteralantibioticsmaybeindicated
- Preceded by AOM
- Young children
- Severe pain, fever, edema over mastoid area
- Intravenous ATB
- Myringotomy ± PE tube
Acute mastoiditis
CLASSIFICATION OF ORBITAL INFLAMMATION
1 inflammatory edema (periorbital cellulitis) 2 orbital cellulitis 3 subperiosteal abscess 4 orbital abcess 5 cavernous sinus thrombosis
- Periorbital erythema, edema, pain & fever
- Purulent nasal discharge
- S. pneumoniae, S. aureus, coagulase-negative staphylococci
- Broad-spectrum antibiotics
periorbital cellulitis
orbital complications of sinusitis?
• Periorbital swelling & pain, fever
• Proptosis, chemosis, restriction of ocular movement & visual
disturbance
managment of orbital complications?
- CT scan – subperiosteal & orbital abscess
- Admission & IV broadspectrum antibiotics
• Surgery (drainage) if
o Failed medication
o Progress of abscess o Visual acuity drop
intracranial complications of sinusitis?
Cavernous sinus thrombosis, meningitis, extradural abscess, intracranial abscess & subdural empyema
• Purulent rhinorrhea, fever, frontal/retro-orbital headache
• Personality change/lethargy, seizure, N/V/, focal neurological
deficits
management of intracranial complications of sinusitis?
Diagnosis – contrast CT/MRI scan with gadolinium
• Admission, IV broad-spectrum antibiotics & surgical drainage
airway obstruction causes in neonatal?
Congenital tumors, cysts, webs
• Laryngomalacia
• Subglottic stenosis
causes of airway obs in children?
Laryngotracheobronchitis • Supraglottitis (epiglottitis)
Foreign body
• Retropharyngeal abscess
• Respiratory papilloma
causes of airways obs in adult?
Laryngeal cancer
• Laryngeal trauma
• Epiglottis & deep neck infection
Pus forms between tonsils capsule & superior constrictor • Group A streptococcus • Hot potato voice • Uvula potato voice • Swollen tonsils • Severe, unilateral sore throat, fever
what condition?
peritonsillar abscess
management of peritonsillar abscess?
I and D to drain the abscess
• Rapid swelling cellulitis of sublingual & submaxillary spaces
• Dental infection, floor of mouth, salivary gland
• Fever, edema & erythema of neck under chin & floor of mouth
Especially if this patient is obese with very short neck very difficult that can be cause of infection.
Open mouth
• Tongue → upward & backward → airway obstruction
• Streptococci, bacteroides, S. aureus
ludwigs angina
management of ludwigs angina?
Tracheostomy
• IV antibiotic
• I&D, tooth extraction
Age 3-7 yrs old
• H. influenzae type B, group A streptococcus
• Severe sore throat & fever, dysphagia, drooling
Because it is swollen the patient is difficulty in breathing
• Stridor
• Breathing with raised chin & open mouth
CBC: leukocytosis
• Film lateral neck → thumb shaped epiglottis
epiglottitis
management of epigottitis
Avoid tongue depressor
• Controlled intubation
• Intravenous ATB
intravenous antibiotic given
Intubation is largely avoided because this is just temporary. If
you can avoid intubation much better to this patient. Because difficult to intubate this patient.
