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Flashcards in ENT Emergencies Deck (87):
1

ENT emergencies of the ear (2)

foreign bodies
malignant otitis externa

2

ENT emergencies of the Nose/Sinus (5)

foreign bodies
epistaxis
nasal fracture
septal hematoma
complications of sinusitis

3

ENT emergencies of the oropharynx (2)

Ludwig's angina
Peritonsillar abscess

4

ENT emergency of the salivary gland (1)

sialoadenitis

5

Which ENT emergency is usually visualized easily and has a primary symptoms of pain?

foreign body in the ear

6

If there is a live insect in the patients ear, what should you do first?

Immobilize insect with 2% Lidocaine or mineral oil


7

How to remove a foreign body in the ear

Alligator forceps
sometimes suction
can try irrigation
If deeply impacted FB, may need to refer to ENT
sometimes FB removal rqrs general anesthesia or conscious sedation

8

Cauliflower Ear: 2 sporty aliases

Wrestler's ear, boxer's ear

9

(U) cause of cauliflower ear

blunt trauma

10

What is cauliflower's ear and does it need to be treated?

Cauliflower's ear is hematoma of the pinna
if untreated, it may result in cartilage necrosis, chronic scarring & deformity

11

Laceration of the Pinna: characteristics, what to watch for & how to tx

(U) bleeds a lot
Make sure there is no injury to the canal & internal ear
Watch out for hemotomas
If laceration needs to be repaired, (U) a running suture is best

12

How can one obtain perichondritis?

-ear piercing, particularly to upper third of the pinna can result in ear infections

-cartilage is avascular, improper healing can predispose to infection (Pseudomonas and Staph)

13

Which two microbes are common in perichondritis?

Pseudomonas
Staph aureus

14

Signs/sxs of perichondritis

pain, erythema & localized warmth

15

Perichondritis treatment: why and what

infections can spread rapidly & lead to deformity
Antibiotics required; surgical debridement

16

Malignant Otitis Externa: broad 1 line definition

invasive infection that involves the temporal bone!!!!

17

In whom do we see Malignant Otitis Externa

IMMUNOCOMPROMISED PATIENTS (diabetics, elderly, systemic malignancy, long term steroid use)

18

Malignant Otitis Externa primary pathogen

Pseudomonas aeruginosa

19

Malignant Otitis Externa a/w which symptoms

severe, unrelenting ear pain that is worse at night
a/w purulent otorrhea

20

As Malignant Otitis Externa spreads, what 3 things may be seen

trismus
cervical adenompathy
CN palsies

21

Malignany Otitis Externa: clinical presentation & dx

ear canal edematous & erythematous w/granulation tissue

CT scan will be DIAGNOSTIC

22

Malignant Otitis Externa: ENT referral for which situations

admission
IV antibiotics: Imipenem or ciprofloxacin or ceftidime

23

Mastoiditis: definition

extension of otitis externa or acute otitis media into mastoid air cells

24

Mastoiditis: signs & symptoms

suspect w/slow resolution of sxs
Mastoid tenderness with edema & erythema
Deep temporal pain

25

Mastoiditis: diagnostic studeis

CT is BEST diagnostic study

plain x-rays might show density in mastoid airspace but may nito be discernible until 2 weeks after onset of mastoid infection

26

Mastoiditis: Tx & prognosis

-Hospitalize & start on IV Abx (Vancomycin or Nafcillin/Oxacillin)
-typmanocentesis for fluid to culture
-mastoidectory required if complications

prognosis is good :)

27

What is the most likely etiology of malignant otitis externa?

Pseudomonas

28

Epistaxis: most common etiology
& other causes of epistaxis

TRAUMA is most common
others: FB, irritants (cig smoke), HTN, nose picking,
meds (ASA, NSAIDS, anticoagulants)
hematologic disorders; hemophilia, leukemia, platelet dysfunction, thrombocytopenia

29

Epistaxis physical exam (3 management elements)

-sitting position preferable to supine
-initial management: direct pressure for a minimum of 5 mins
-ensure hemodynamic stability & airway patency

30

Epistaxis: equipment used is in physical exam

-bright light source (headlight)
-nasal speculum
-adequate suction
-adequate protection against blood exposure (goggles, apron, gloves)
-adjustable chair (ENT or dental chair)

31

Epistaxis: usual source of bleeding in kids

Kiesselbach's Plexus
anteriorly on the nasal septum branch of the labial artery

32

Epistaxis: adult usual source of bleeding

in septum, but more posterior than kids

33

Epistaxis: elderly usual source of bleeding

elderly (U) most difficult to identify & control
branch of the MAXILLARY ARTERY
POSTERIOR, harder to visualize
more bleeding, more systemic factors

34

Anterior nose bleed tx

Topical vasoconstrictors: 2%Neo-synephrine spray, 4% cocaine spray or solution on cotton pledgets

Cautery: chemical (silver nitrate), hemostatic packing material-Gelfoam or Surgicel, electrocautery

Anterior packing: petrolatum-impregnated gauze packed firmly in the anterior nares with forceps, leave for 48 hours (preformed nasal tampon may be used)

35

Posterior nose bleed tx and complications

Vasoconstrictor: pledgets saturated in 4-5% cocaine
Anterior packing
Posterior packing:
-posterior pack + anterior nares bilaterally
-balloon catheter: left in place for 2-5 days
-HOSPITALIZE if posterior pack or balloon catheter

Complications: septal hematoma, sinusitis, toxic shock syndrome

36

Nasal fracture: (U) cause, may be a/w what

very common injury, (U) from blunt trauma
-may have associated epistaxis (need to evaluate for septal hematoma)

37

non-displaced nasal fracture: immediate needs

generally don't require immediate intervention
ENT referral in 3-5 days

BLOOD w/surrounding STRAW-COLORED FLUID OR SEROUS FLUID->think other facial fractures, need URGENT NEUROSURGICAL consultation

38

Septal hematoma: When seen, (C) in whom

seen following trauma
more common in pediatric patients

39

Septal hematoma: symptoms (3), Physical exam (3)

sxs: increased nasal obstruction, pain, tenderness

PE: soft, tender, swelling

40

Nasal Hematoma tx

-incision & drainage of hematoma to prevent avascular necrosis
[untx hematomas complicated by "saddle nose" deformity]
after drainage, pack nose and cover w/antibiotics

41

When do you avoid irrigation of the nose

if foreign body is vegetable matter

42

What can you have a parent do if their child has a foreign body in his mose?

can have parent try to blow it out

43

What is necessary for nose foreign body removal in a child

child must be adequately restrained and you must have good visualization

44

When do you refer nasal FB to ENT

if more than 2 unsuccessful attempts, refer to ENT

45

Foreign body in nose: when to re-examine

ALWAYS re-examine after 1 FB removed

46

4 potentially life-threatening complications of sinusitis

[result from extension of a bacterial infection into the orbital or intracranial spaces]
1. Periorbital cellulitis
2. Orbital cellulitis
3. Cavernous sinus thrombosis
4. Frontal osteomyelitis

47

Periorbital Cellulitis def & may be a complication of what

infection confined to the eyelids, may be a complication of sinusitis or local disruption of skin

48

Periorbital cellulitis: 2 most common pathogens

S. pneumo
S. aureus

49

Periorbital cellulitis: ddx includes (3)

trauma, contact allergy, dacryocystitis

50

Periorbital cellulitis: symptoms (4)

unilateral periorbital edema with erythema, warmth, tenderness, fever

51

Physical exam findings suggestive of ORBITAL cellulitis

VISION LOSS, DIPLOPIA, & PROPTOSIS suggest intraorbital involvement consistent with orbital cellulitis

[on exam, assess visual acuity & EOMs)

52

Perioribital Cellulitis: dx & tx

-CT scan most helpful to dx
-hospitalize anyone who is febrile & appears acutely ill
-IV Abx
-consult ophthamologist and/or ENT
prognosis is good if tx started early

53

Orbital cellulitis can lead to what

TRUE EMERGENCY, can lead to:
vision loss
meningitis
cavernous sinus thrombosis
frontal abcess

54

Orbital Cellulitis: what will you see

periorbital edema, erythema PLUS proptosis, chemosis, impaired EOMs & evidence of vision loss

55

Orbital cellulitis dx

CT WILL DISTINGUISH between periorbital cellulitis and orbital cellulitis

56

Orbital cellulitis tx

Admit for IV Abx:
Nafcillin + Ceftriaxone + Metronidazole

57

Cavernous Sinus Thrombosis Sxs

sxs develop acutely, w/in 1 week after infection
-severe unilateral, retro-orbital headache
-bilateral proptosis
-ophthalmoplegia
-vision loss
-SENSORY DYSFUNCTION: hypo-/hyperesthesia of cranial nerve V, 1st branch

58

Sensory nerve dysfunction on Cavernous Sinus Thrombosis is due to

hypo-/hyperesthesia of Cranial Nerve V, 1st branch

59

Cavernous Sinus Thrombosis appearance on exam

Febrile, toxic appearing pt
Periorbital edema
Cranial Nerve dysfunction (III, IV, VI)
Papilledema (late)

60

Cavernous Sinus Thrombosis: dx and tx

need URGENT head CT
IV Abx: Vancomycin + Ceftriaxone

61

Frontal Osteomyelitis aka & a/q

Pott's Puffy Tumor
is a complication a/w frontal sinusitis

62

Frontal Osteomyelitis most common microbes

S. aureus & anaerobes

63

Frontal Osteomyelitis: patient presentation

patient presents w/HA & progressive swelling of the forehead

64

Frontal Osteomyelitis dx

CT or MRI will be dx

65

Frontal Osteomyelitis tx

drainage of abscess & debridement of infected bone
IC Abx: Vancomycin or Nafcillin

66

Tongue laceration: cause & what is the problem

(U) related to injury, frequently involving the teeth

Great potential for INFECTION & HEMATOMA

67

Tongue Laceration tx

almost never sutured, exception: tip of tongue (forked tongue)
-may need to suture if more than 1/3 of the width of the tongue involved
-absorbable suture material, Abxs

68

Puncture wounds in the mouth: etiology, description

common but rarely serious
running with something in mouth or run into something
almost always small
bleeding resolves spontaneously

69

Puncture wounds in mouth tx

-start on Abx (possibly only when more serious?)
-rinse w/ warm water after every meal
-will resolve without tx
-topical anesthesia for pain control
-can use orabase dental paste to prevent irritation, but doesn't speed healing
-solution of Maalox & liquid Benadryl (1:1)

70

What ENT condition presents with uvula displacement?

Peritonsilar abscess

71

Ludwig's Angina: what is this?

infection involving the submandibular space
potential spread can compromise oral cavity, airway & deep neck spaces

72

85% cases of Ludwig's Angina are the result of what
-can also see with what?

85% are the result of a dental infection
-can also see with a peritonsillar abscess, oral malignancy or mandibular fracture

73

Ludwig's Angina: 3 common pathogens

Streptococcus, Staphylococcus & Bacteroides

74

Ludwig's Angina sxs and associated conditions

-rapidly progressive infection a/w neck swelling, tongue protrusion & severe pain
-also see malaise, trismus & bad breath

75

Ludwig Angina: tx

-ENT consultation for potential airway compromise & surgical debridement
-IV Abx

76

Most common abscess of the head and neck

peritonsillar abscess

77

"hot potato" voice seen in

peritonsilar abscess

78

Signs and symptoms of peritonsilar abscess

fever, severe sore throat, drooling odynophagia & otalgia
signs: trismus, unilateral erythema & swelling, displaced uvula

79

Peritonsillar Abscess tx

drainage of abscess and Abx

80

Sialoadenitis: definition, etiology, 2 types

-inflammation of any of the salivary glands (parotid, submandibular, sublingual)
-viral or bacterial etiology

Forms:
Suppurative-most(C)cause:Staphylococcous aureus
Obstructive-occurs fro a stone or calculus in salivary gland or duct

81

Sialoadenitis presentation

pts are: elderly, diabetic, poor oral hygiene, dehydration
-enlarged, swollen, painful mass
w/stone: xerostomia & worsening pain & swelling during mealtime

82

Bilateral swelling of a gland may be due to

VIRAL sialoadenitis

83

Bacterial Sialoadenitis presents: (Uni or bi-laterally)

UNILATERAL

84

Viral Sialoadenitis presents (uni- or bi-laterally)

BILATERAL

85

Unilateral swelling of a gland may be due to

bacterial sialoadenitis

86

Tx of sialoadenitis

Suppurative: Abx tx to cover Staph
Rehydration, proper oral hygiene
surgical irrigation & drainage

Obstructive: most stones pass spontaneously without complication
lozenges to stimulate salivary secretions

87

Serum amylase will be elevated in which ENT Emergency lecture condition?

Sialodenitis