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Reade Rent Emergencies 1

Reade Rent Emergencies 1

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Published by: cafemed on Oct 29, 2009
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06/04/2010

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ENT Emergencies

Mark E Reader DO, FAOCO

Epistaxis

Anterior vs Posterior
– Anterior more common in children – Posterior more common in older adults

Posterior more difficult to control  Check for ASA, anticoagulants, & herbs  Nasal canula / percutaneous O2  Trauma, tumor, foreign body, & environment

Anterior Epistaxis

  

Usually anterior nasal septum (Kiesselbacks plexus) Inferior turbinate other location Easilly identified with nasal speculum Control with cauterization +/anterior pack

Posterior Epistaxis

Unable to visualize bleeding site Can lose large volume quickly Treatment options:
– posterior/ anterior pack – Nasal endoscopy with cauterization – Artery ligation

Packing Tray

Posterior Epistaxis

Posterior Epistaxis

Septal Perforation

Septal Hematoma

 

Swelling of nasal septum that doesn’t respond to decongestant spray Need drained < 48 hrs Complications:
– – Infection Saddle nose

Drain & pack, antibiotics

Septal Hematoma

Septal Hematoma

Septal Hematoma

Nasal Foreign Body

Symptoms:
– Usually brought in by mother – Unilateral rhinitis / epistaxis

Diagnosis:
– – – Nasal speculum Rhinoscopy X-ray

Treatment

Foreign Body Aspiration

Most prevalent under age 4 Smaller objects aspirated/ larger swallowed Laryngeal objects – potential airway emergency

Foreign Body cont.

Remove in controlled fashion
– Laryngeal: ASAP – Bronchial: same day of diagnosis – Esophageal: variable

Peritonsillar Abscess

  

Sudden increase in pain Difficulty swallowing Displacement of uvula Unilateral swelling of anterior tonsil pillar

Peritonsillar Abscess

IV hydration
– Antibiotic – Steroid

 

Local anesthetic I&D

Peritonsillar Abscess

Epiglottitis
 

True emergency High index of suspicion Dx with X-ray & in OR

Auricular Hematoma

 

Blunt trauma (wrestler) Drain with temp drain/ packing with in 48hrs Antibiotics Complications:
– Infection – Cauliflower ear

Auricular Hematoma

Auricular Hematoma

Foreign Body Ear

Emergency when associated with vertigo, profound hearing loss and/ or facial parallysis Do not irrigate organic material or with a perforation Otologic ear gtts / ENT eval

Tympanic Membrane Perforation

Etiology
– Infection, penetrating trauma, temporal bone fracture

 

Check for conductive hearing loss with tuning fork Tx: Floroquinolone gtts, no H2O More serious injury with: profound SNHL,vertigo, or otorhea

TM Perforation cont.

Sudden Hearing Loss

History
– – – – – – Timing Severity Location Inciting factors Medications Associated symptoms

Exam
– – – – – Conversation Otoscopic Tuning fork CT Lab
» » » » VDRL Sed rate Lyme Blood glucose

Sudden Hearing Loss

Treatment
– Cause dependent – Early intervention may make a difference – May need to treat associated symptoms as well

Facial Trauma

Repair lacerations < 12 hrs Check distal neuro status Irrigate aggressively with minimal debridement Meticulous closure

Hematoma

Facial Fractures

R/O cervicle fracture and stabilize airway 1st Diagnose with exam/ XRay Reduce once swelling down Rx: Antibiotic and pain control

Nasal Fracture

Concluding Remarks

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