ENT emergencies

Question 1

2 main blood supplies to the nose

Answer 1

1. ICA

2. ECA

Question 2

where is most common site of nose bleeds

Answer 2

little’s area

• at location of kisselbach’s plexus
• large anastamosis

Question 3

7 general local causes of epistaxis and most common

Answer 3

1. trauma - most common
2. barometric changes
3. dryness
4. septal perf
5. chem
6. tumors
7. inflammation

Question 4

3 general systemic causes of epist

Answer 4

1. coagulopathies
2. granulomatous disorders
3. vascular

Question 5

8 things to assess in initial epist

Answer 5

1. airway patnecy
2. vitals
3. maintain P on nose
4. assess blood loss and side of bleeding
5. PmHx
6. IV access if indicated
7. bloodwork
   - CBC
   - INR/PTT

Question 6

3 keys to exam

Answer 6

1. good light
2. suction
3. anasthesia/vasoconstriction

Question 7

increasing steps of mgmt of epistax

Answer 7

1. silver nitrate - chem cautery
2. gelfoam or surgicel - absorbable
3. inflatable nasal cath - tamponade
4. merocel sponge - absorbes
5. vaseline gauze

Question 8

if none work, then what

Answer 8

1. patient coagulopathy?
2. HT?
3. pack inadequate
4. bleed posterior?

Question 9

what to do for posterior bleed

Answer 9

posterior pack - trace a foley cath back in

Question 10

what if posterior pack dont work (2)

Answer 10

1. embolization - can only do ECA

2. surgical ligatio

Question 11

where does infection accumulate in necks

Answer 11

in the spaces

- between fascia

Question 12

most common Sx of neck space infection (2)

Answer 12

1. sore throat

2. odynophagia

Question 13

Sx that tell you there is something more nefarious happeneing

Answer 13

• fever
• decreased PO
• otalgia
• neckpain
• toricollis
• swelling

Question 14

6 most common causes

Answer 14

1. odontogenic
2. tonisllitis/pharyngytis
3. sialodentis
4. IV drugs
5. trauma
6. iatrogenic

Question 15

main imaging for neck

Answer 15

CT

Question 16

3 main aspects of mgmt

Answer 16

1. airway protectiong
2. antimicrobials
   - Gr- cocci
   - anaerobes
3. most need surgical drainage

Question 17

5 possible complicatios of neck space infection

Answer 17

1. airway obs
2. mediastinitis
3. sepsis
4. IJV thrombosis - throw clots all over
5. life threatenin hemmorage

Question 18

def. of sudden SN hearing loss

Answer 18

hearing loss in 3 cont. hx of 30dB

• onset in less than 24 hrs
• normal middle ear
• EMERGENCY

Question 19

4 parts of work-up for sudden hearing loss

Answer 19

1. complete H+P
2. audiogram
3. labs
4. MRI gadolinium

Question 20

Tx of sudden loss

Answer 20

systemic prednisone

- can possibly do intratympanic

Question 21

what is bell’s palsy

Answer 21

acute but limited facial palsy

• rapid onset
• diagnosis of exclusion
• idiopathic

Question 22

what is outcome

Answer 22

paresis - 95% recover

paralysis - 71% recover

Question 23

Tx of bell’s

Answer 23

obseve

- roids in first couple of weeks.