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Q4 EM Surg > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

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1
Q

ENT emergencies of the ear (2)

A

foreign bodies

malignant otitis externa

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2
Q

ENT emergencies of the Nose/Sinus (5)

A 
foreign bodies
epistaxis
nasal fracture
septal hematoma
complications of sinusitis
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3
Q

ENT emergencies of the oropharynx (2)

A

Ludwig’s angina

Peritonsillar abscess

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4
Q

ENT emergency of the salivary gland (1)

A

sialoadenitis

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5
Q

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

A

foreign body in the ear

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6
Q

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

A

Immobilize insect with 2% Lidocaine or mineral oil

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7
Q

How to remove a foreign body in the ear

A

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

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8
Q

Cauliflower Ear: 2 sporty aliases

A

Wrestler’s ear, boxer’s ear

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9
Q

(U) cause of cauliflower ear

A

blunt trauma

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10
Q

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

A

Cauliflower’s ear is hematoma of the pinna

if untreated, it may result in cartilage necrosis, chronic scarring & deformity

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11
Q

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

A

(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

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12
Q

How can one obtain perichondritis?

A
  • 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)
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13
Q

Which two microbes are common in perichondritis?

A

Pseudomonas

Staph aureus

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14
Q

Signs/sxs of perichondritis

A

pain, erythema & localized warmth

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15
Q

Perichondritis treatment: why and what

A

infections can spread rapidly & lead to deformity

Antibiotics required; surgical debridement

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16
Q

Malignant Otitis Externa: broad 1 line definition

A

invasive infection that involves the temporal bone!!!!

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17
Q

In whom do we see Malignant Otitis Externa

A

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

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18
Q

Malignant Otitis Externa primary pathogen

A

Pseudomonas aeruginosa

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19
Q

Malignant Otitis Externa a/w which symptoms

A

severe, unrelenting ear pain that is worse at night

a/w purulent otorrhea

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20
Q

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

A

trismus
cervical adenompathy
CN palsies

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21
Q

Malignany Otitis Externa: clinical presentation & dx

A

ear canal edematous & erythematous w/granulation tissue

CT scan will be DIAGNOSTIC

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22
Q

Malignant Otitis Externa: ENT referral for which situations

A

admission

IV antibiotics: Imipenem or ciprofloxacin or ceftidime

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23
Q

Mastoiditis: definition

A

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

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24
Q

Mastoiditis: signs & symptoms

A

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

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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

Q4 EM Surg (27 decks)

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