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Flashcards in ENT Emerg Deck (31):
1

Tx of Hematoma of the Pinna

I and D

Pressure dressing and 48 hr f/u

Abx pphx

2

Best way to remove cerumen impaction

Ear irrigation- if cerumn is hard use softners (debrox, cerumenex, docusate)

3

Whst can you use to help dissolve a styrofoam foreign body, superglue or cyanoacrylate?

acetone

4

Abx if trauma during foreign body removal to ear

dexamethasone

5

When does otitis externa become chronic

>6 wk

6

otitis externa with progression to include deeper tissues / structures, hx of DM or immunocompromised

Necrotizing / malignant otitis externa

7

Otitis externa tx

Topical- non-ototoxic only, antibiotic drops (pseudomonas), analgesics

Oral antibiotics

Admission for necrotizing

8

Abx for otitis externa

Acetic acid solution

Neomycin, polymyxin B, and hydrocortisone (Cortisporin Otic). Suspension if TM ruptured

Ofloxacin (Floxin Otic). 3-4 drops bid or Ciprodex (ciprofloxacin/dexamethasone)

Acetic acid in aluminum acetate (Domeboro)-drying agent (Eczema etiology only)

Tinactin/ Micatin solution (Fungal etiology only)

Clotrimazole 1% solution

9

Etiology of mastoiditis

S. pneumoniae, S. pyogenes, S. aureaus

10

Tx of mastoiditis

ENT consultation

Admission

IV antibiotics: Cefotaxime, 1 g IV q 24 h, or ceftriaxone, 1-2 g IV q 24 hours

11

If TM perforated what side does weber lateralize to?

side of perf

12

TM perf tx

Keep ear dry

Refer to ENT and audiology

TM perforation from infectious etiology- Cortisporin Otic Suspension 1 drop qid, Ciprofloxacin Ophthalmic (Ciloxan) 1 drop qid

Traumatic TM perforation- no Abx needed

Urgent referral if hearing loss and/or vertigo

Surgical repair typically not needed

13

abrupt onset of pain, feeling of fullness in ear, conductive hearing loss, dizziness, tinnitus, vertigo, nausea/vomiting, transient facial paralysis, TM rupture with Valsalva maneuver, crying in children

Barotrauma

14

Barotrauma etiology

Air travelers, scuba diving, decompression, hyperbaric oxygen chambers, or rapid pressure change, or
blast injuries

15

Barotrauma tx

open the eustachian tube: chew gum, Valsalva maneuver, yawn, infants/kids should drink something during the landing/takeoff, divers descend and ascend slowly

Meds: antihistamines, decongestants, antibiotics to prevent infection, if barotrauma is severe, surgery

16

Middle Ear Hematoma tx

Watchful waiting

No antibiotics unless signs of infection develop

Follow-up with ENT and audiometry

17

Middle Ear Hematoma prognosis

Hearing can go back to baseline if the ossicles have not been fractured or dislocated

Hearing should return to normal in 6-8 weeks

18

Etiology of AOM

Streptococcus or parainfluenza or RSV

19

AOM tx

1st line: Amoxicillin 500 mg p.o. tid x 7-10 days

2nd line: Augmentin 875 mg p.o. bid x 7-10 days;
Ceftin 500 mg p.o. bid x 7-10 days

Penicillin allergic patients: Azithromycin, Clarithromycin, Clindamycin

20

Peripheral Vertigo Management

IV hydration (for patients with prolonged nausea or poor fluid intake)


1st line: Meclizine (Antivert) 25-50 mg po q 8-12 hours or Diazepam (Valium) 5-10 mg IV or 2-4 mg IM or transdermal scopolamine 0.5mg patch if patient unable to tolerate liquids

Anticholingerics: diphenhydramine (Benadryl) 50 mg IM or PO q 6-8 hours, dimenhydrinate (Dramamine) 50-100 mg IM or PO q 4 hours, promethazine (Phenergan) 25 mg PO, PR, or IV every 6-8 hours

21

Vertigo Management

d/c w/ mod improvement of sx and can tolerate liquids

if central- mgmt for underlying cause

22

vertigo prognosis

symptoms can last several hours to 1 week but may persist for 4-5 weeks

23

Labyrinthitis mgmt

Sx tx

Visual-vestibular exercises for prolonged causes

Lie still with eyes closed in darken room during acute
attack

Medications: for vertigo, abx, antivirals

24

unilateral hearing loss, tinnitus and vertigo with sudden onset and short (1-24 h) duration (intense, recurrent, vertigo associated with nausea and vomiting and distress, ear pressure, nystagmus during attacks)

Meniere’s Disease

25

Meniere’s Disease tx

low salt diet, meds for vertigo, surgery for severe cases

26

MC site of epistaxis

anterior septum / Kiessellbach’s Plexus

27

MC arterial source of posterior epistaxis bleeding

sphenopalatine artery

28

Approach to anterior epistaxis

Direct pressure for continuous 20 min - pre-treat with Oxymetazoline

Topical anesthesia and vasoconstriction

Tranexamic acid on cotton ball

Evacuate blood clot and ID bleeding source

29

How long is anterior packing typically needed for

24-48 hours

30

How long is posterior packing typically needed for

72-96 hours

31

epistaxis after care

pphx for pts w/ comorbid: Cephalexin, amoxicillin, bactrim will dec risk of sinusitis and toxic shock syndrome

bacitracin bid x 1
week if cauterized

topical saline spray and saline gel to moisturize nasal mucosa of unpacked side