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ENT Emergencies Flashcards

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1
Q

Presentation/sx of jaw dislocation

A
  1. Locked jaw,
  2. pain,
  3. difficulty swallowing,
  4. malocclusion
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2
Q

Most common form of jaw dislocation

A

anterior dislocation

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3
Q

how do you DX and TX jaw dislocations

A

DX: clinical
-imaging if trauma

Tx: reduction

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4
Q

PEX findings of otitis externa

A
  1. Erythema/edema external auditory canal
  2. Pain w/ movement of the pinna/tragus or insertion of the speculum

Hx: Pruritus, pain, external ear TTP

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5
Q

Tx of otitis externa

A
  1. Topical Antibiotic Drops
    - Acetic acid/hydrocortisone
    - Cipro/Hydrocortisone
    - Ofloxacin
  2. +/- Wick/guaze– allows you to put medicine in the ear w/ significant edema
  3. Keep ear dry for 3 days
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6
Q

Who most commonly gets malignant OE

A
  • life threatening
    1. elderly
    2 diabetic
    3. immunocompromised
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7
Q

Sx of Malignant OE

A
  1. Pain out of proportion**

2. possible CN involvment

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8
Q

How do you Dx an TX malignant OE

A

DX: CT

Tx: ENT consult, IV abx, admit

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9
Q

What are the most common causes of AOM

A 
*Mostly viral ;70%
If bacterial: 
1. Strep pneumoniae
2. Haemophilus influenzae
3. Moraxella catarrhalis
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10
Q

Presentation of AOM

A
  1. Otalgia
  2. w/ or w/o fever
  3. pain
  4. retracted or bulging TM w/ erythema
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11
Q

Tx of AOM

A
  1. Ibuprofen/Tylenol
  2. antibiotics-Amoxicillin (age dependent)
    <6months = Abx
    6m-2yrs= you decide
    >2y/o= recommend sx management

*IF OTHERWISE HEALTHY, LOOK WELL, CONSIDER WATCH AND WAIT (<72 HOURS OF SYMPTOMS)

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12
Q

Presentation/Findings of mastoiditis

A
  1. tender to palpation over mastoid
  2. +/- swelling over mastoid
  3. common in elderly and immunocompromised ppl
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13
Q

How do you DX and TX mastoiditis

A

DX: CT

TX: ENT consult, IV abx, +/- surgery

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14
Q

Presentation/Findings of Bullous Myringitis

A
  1. Sudden onset of pain
  2. usually no fever
  3. inflammation w/ blebs
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15
Q

What is the TX of Bullous Myringitis

A
  1. Analgesics

2. Abx if recurrent AOM (secondary purulent body)

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16
Q

What meds should you avoid with TM perforations

A

ototoxic meds

  1. gentamicin
  2. neomycin
  3. tobramycin
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17
Q

How do you tx TM perforation

A
  1. Cipro Otic SUSPENSION, not solution
  2. keep ear dry for at least 1 week
  3. Refer to ENT for f/u
  4. always explore possibility of domestic violence
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18
Q

What is a auricular hematoma

A

Collection of blood between cartilage and perichondrium

Hematoma prevents adequate oxygen delivery to the cartilage

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19
Q

Auricular hematoma can lead to

A
  1. necrosis

2. cauliflower ear

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20
Q

What is the TX of auricular hematoma

A
  1. Aspiration or drainage
  2. Compressive dressing- make sure skin is up against cartilage to prevent reaccumulation
  3. Antibiotics
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21
Q

How do you manage an ear laceration?

A
  1. numb ear first w/ epi
  2. Close the cartilage first with 5/6-0 vicryl (try to approximate the more superficial perichondral layer rather than piercing the fragile deeper mid cartilage)
  3. close the external skin with non absorbable nylon 6-0
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22
Q

Don’t use epi on what body parts

A

fingers, nose, penis toes

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23
Q

Common FB that get stuck in Adult and kids ears

A

Adult: cotton, hearing aid, insects

Kids: rocks, candy, beads, or anything

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24
Q

Removal techniques for ear FB removal

A
  1. Angiocath irrigation— organic matter may swell w/ liquids
  2. pick ups
  3. Dermabond on end of Q-tip (Abx ointment helps remove dermabond)
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25
Always assess for ___ and __ injuries w/ Ear FB
TM injury | EAC injury
26
Sources of epistaxis
1. Anterior nosebleeds (90+%) 2. from Kiesselbach's Plexus (nose picking zone- medial aspect of nose) 3. Posterior nosebleeds- mores serious
27
Causes of epistaxis
1. trauma 2. FB 3. Picking 4. tumor 5. humdity 6. Oxygen 7. dry air *common in elderly on blood thinners
28
Describe the management of Epistaxis
1. Blow nose to get clot out 2. Use Afrin for vasoconstriction then blow again 3. Quick look w/ specululm 4. put cotton ball w/ lidocaine and epi 5. Put nose clip on and come back in 20 min. 6. Try silver nitrate briefly 7. Use Rhino rocket/tampon goes straight back/parallel to floor for pressure from inside (add 2-3cc of air) 8. Packing out after 3-4 days (2 days maybe ok or longer if on blood thinners), concern for TSS. Abx – keflex, augmenitn (creating a close anerobic environment)
29
Describe the management of posterior epistaxis
1. ABC 2. IV access 3. Labs - CBC, Type and Screen, Coags 4. Packing-- harder to get to so use a longer rocket packing 5. ENT Consult 6. Observation-- might need overnight observation
30
What labs should you check w/ posterior nose bleeds
1. CBC 2. Type and screen 3. Coags
31
W/ nasal fractures it is important to r/o __. | Why?
septal hematoma --Can affect airway and may cause deformity/damage to the cartilage *Imaging infrequently needed (clinical dx)
32
Describe the management of nasal fractures
1. Rarely reduce nose in ER due to swelling 2. Ice, Analgesics 3. F/U w/ ENT (usually in a week and swelling should be down by then) 4. Warn patients about ecchymosis/swelling
33
What is the tx of septal hematoma
1. Drainage 2. ENT f/u *don't pack but you do drain!
34
Common Adult and ped nasal FB
Adults: jewelry kids: anything, beads, popcorn, legos, cotton, clothign, candy, rocks
35
Describe the removal of nasal FB
1. Occlude the non-affected nostril with a finger, quick puff in the childs mouth may cause the item from coming out 2. use pickups
36
presentation of sinusitis
1. congestion 2. facial pain/pressure 3. nasal discharge 4. dental pain 5. +/- fever
37
Complications of sinusitis
1. Meningitis, 2. cavernous sinus thrombosis, 3. abscess, 4 orbital cellulitis, 5. osteomyelitis.
38
How do you Dx and TX sinusitis
DX: clinical dx TX: 1. decongestants - Afrin, Pseudoephendine <3 2. nasal steroid 3. Abx after 10 days or looks ill
39
Presentation of cerumen impaction
1. Patients typically present with hearing loss, 2. pressure/pain, 3. tinnitus *Can be caused by excessive use of cotton swabs
40
Tx of cerumen impaction
1. Soften first with Debrox, Cerumex, Colace 2. Warm saline irrigation +/- manual removal 3. Reevaluate after removal for TM/abrasion
41
Describe the Le Fort Fractures
I- alveolar ridge II- zygomatic maxillary complex III- cranio facila dysostosis (laxation-worse) *if concerned get CT of face w/o contrast
42
If you have a facial fx w/ rhinorrhea consider ___
CSF leak
43
Do the ___ test to check for jaw fractures
tongue blade test
44
W/ orbital fractures always consider ___ and check ___
1. mechanism 2. global injury 3. document EOM (entrapment) 4. visual acuity
45
what is the TX of orbital fx
1. call ENT and plastics 2. ABX 3. analgesics
46
Describe how entrapment can occur w/ orbital fractures
Blunt force strikes the globe and transmits the force through the eye, fracturing medial or inferior orbital wall No nose blowing at d/c *Disconjugated vision
47
Describe how you count teeth
start w/ upper right 1 and go around and down Top central incisors: 8-9 Bottom central incisors: 24-35
48
Describe Ellis I dental trauma and its TX
Enamel Only- -refer for outpatient dental follow up
49
Describe Ellis II dental trauma and its TX
Through the creamy yellow Dentin – Cover with Dycal and follow up within 24 hrs
50
Describe Ellis III dental trauma and its TX
Exposed Pulp (red) -Dycal and immediate dental referral
51
Describe the management of a tooth avulsion
1. Reimplant asap 2. Do not rinse or scrub. Can gently irrigate the socket with sterile saline prior to reimplantation. Do NOT handle to root. 3. If you can’t reimplant immediately, place in a sterile nutrient solution – sterile saline, milk, saliva, Hank’s solution 4. Do no reimplant primary teeth 5. Reimplant within 3 hours to save the periodontal ligament fibers
52
What solutions can you place an avulsed tooth if it cannot be reimplanted immediately
1. Sterile saline 2. milk 3. saliva 4. Hank's solution
53
Reimplant an avulsed tooth within ___ to save the periodontal ligament fibers
3 hours
54
Describe the approach to dental pain
1. R/O other causes 2. Offer Blocks 3. Antibiotics 4. Pain Meds * frequent ED complaint on weekends/evenings * *Pain med seeking usually decline dental blocks
55
Describe where you can do facial blocks
1. Supratrochlear nerve (above eyebrow--gets forehead) 2. Mental-- chin and bottom lip 3. Infraorbital-- upper lip and cheek
56
Describe the management of dental abscess
1. drainage 2. ABx 3. dental FU
57
Treatment of thrush
1. antifungal rinses - Nystatin - Lozenges - Clotrimazole
58
Causes of thrush in adults
1. diabetes 2. steroids 3. HIV
59
Inflammation of one or both parotid glands (salivary glands)
parotitis
60
causes of Parotitis
1. Infectious- staph, TB 2. Viral- Mumps (typically bilateral) Blockage - stone, mucous plug, lymph node +/- with infection
61
How do you DX and Tx of Parotitis
DX: clinical TX: sialogogues (lemon drops), +/- antibiotics, +/- stone removal
62
Describe the Centor score for pharyngitis
1. Fever 2. Age <15 or >44 3. Tender cervical LAD 4. Exudates 5. Absence of cough/URI sx TX: 0-1 Points – Nothing (< 10% GAS) 2-3 Point – Test (15- 30% GAS) >4 – Treat (>50% GAS)
63
Describe the presentation of a peritonsillar abscess
1. Severe Sore Throat 2. Trismus 3. Uvula Deviation** 4. Asymmetric Swelling 5. Muffled Voice *Feel posterior pharynx normal side first and then the affected side feels boggy and red
64
Describe the tx of a peritonsillar abscess
1. Drainage-- quick relief w removal of any pus 2. Antibiotics (Clinda 600 IV) 3. Steroids (Decadron 10 IV 4. ENT consult/follow up
65
Describe the PEX of Ludwig's Angina
1. Pain/swelling to floor of mouth 2. Difficulty with speech 3. Trismus 4. Neck Pain/Swelling 5. Redness 6. Tongue deviation 7. Fever/Chills
66
How do you DX and TX Ludwig's Angina
Dx: CT (of neck WITH IV contrast) TX: IV abx, admit, ENT consult
67
Presentation of epiglottitis
1. Drooling 2. dysphagia 3. +/- fever 4. stridor 5. Muffled, HOT POTATO VOICE 6. Sore throat, rapid progression 7. SICK appearance (H. flu)
68
CXR: Thumbprint sign
(narrowing of epiglottis) | Epiglottitis
69
Tx of Epiglottitis
1. ENT/Anesthesia Consult possible intubation 2, Keep patient calm, positive of comfort-- limit oral manipulation for PE bc can cause airway decompensation -NO ORAL FLUIDS--> give IV 3. Oxygen/secure airway
70
Presentation of croup/laryngotracheitis
1. bark like cough 2. stridor 3. hoarseness
71
cause of croup
Epi: Viral (parainfluenza virus primarily) Pathophys: swelling of larynx, trachea, bronchi. Upper airway obstruction - stridor
72
How do you Dx and TX croup
Dx: clinical TX: 1. dexamethasone oral or IM 2. racemic Epi 3. observation 4. f/u "CRP"
73
Presentation of Bronchiolitis
1. <2y/o 2. coughing 3. wheezing 4. congestion 5. fever *RSV
74
TX of bronchiolitis
1. supportive – nasal suction, fluids, antipyretics. 2. Admit if Hypoxic *consider CXR, influenza testing
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