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Emergency Med Final > ENT emergencies > Flashcards

ENT emergencies Flashcards

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1
Q

ENT emergencies

A 
maxillofacial trauma
facial, periorbital infxns
ear emergencies
nose & sinus d/o's
oral cavity & pharyngeal d/o's
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2
Q

maxillofacial trauma

A 
often impressive appearance
ABC's- airway risk?
C-spine a priority
facial trauma= head trauma
VS resolving?
EtOH common
other injuries
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3
Q

maxillofacial trauma Hx

A 
what happened & when?
fall? why fall? MVA? Assault
LOC? vomiting? can't walk?
visual sx's?
facial anesthesia/paresthesia?
condition of teeth, bite, blown nose (avoid doing this, may lead to air in areas it shouldn't be)
PMH, meds, tetanus
police report made?
domestic violence? child abuse?
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4
Q

maxillofacial trauma PE

A

look from above/below/side for ASYMMETRY
whistle, smile, wrinkle forehead
eyes: visual acuity (Rosenbaum card), periorbital (edema, crepitus, lacerations), EOM’s, pupils, conjunctiva, anterior chamber (symmetry, subconjunctival, hemorrhage, hyphema)

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5
Q

PE of oral cavity

A 
full, gloved exam
lips- lacs, hematoma, thru/thru, vermillion
trismus or can't close?
teeth present & intact? where are they?
alveolar ridge, frenulum attachment 
bleeding in mouth
tongue-lacs
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6
Q

PE of nose

A

locate, control bleeding
nasoseptal hematoma
palpate medial canthus for mobility

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7
Q

PE of ears

A

drainage (blood, CSF)
ear lac?
auricular hematoma, Battle sign
TM’s- hemoptypanum, rupture

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8
Q

PE & palapation

A

palpate entire face, both hands
look for tenderness, bony crepitus, subq air, flattening, anesthesia
plapate entire orbital rim
check if anterior maxillary arch is stable-if it moves at all, stop!
intraoral palpation of zygomatic arch

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9
Q

how do you check for a mandible fx?

A

use a tongue blade & ask them to bite down on it & try to pull it out. if they can bite down on it & hold onto it, likely no fx

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10
Q

don’t forget other organ sx’s- do quick look over

A 
scalp
neck
neuro exam, CN exam
chest wall, LUs, heart, abdomen
extremities, pelvis
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11
Q

mngt of maxillofacial trauma

A 
ABC's, suction
consider IV- pain ctrl, Abx; tetanus
pain ctrl- IM/IV or topical (eyes, nose)- avoid po's
imaging- CT preferred over plain film
make dx before calling consultant
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12
Q

preferred CT image for mandible?

A

Panorex

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13
Q

frontal sinus/bone fx

A

significant mechanism needed
step-off, forehead lacs
high risk for intracranial injury, dura tear
bony crepitus, deformity, subq air, limited upward gaze, ptosis, sensory deficit forehead
CT, Abx, OMFS, admit

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14
Q

pediatric considerations

A

frontal bone injury more common- check those lacs carefully
higher incidence of intracranial trauma w/ frontal bone fx- consider CT head
upper C-spine injury more common than lower in kids
non-accidental facial trauma? abuse?
development, cosmetic deformities- consider these

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15
Q

nasoethmoidal-orbital Fx’s

A 
small NEO Fx's easy to miss
trauma to bridge, medial orbits
associated w/ lacrimal injury & dural tears
pain at medial bridge, w/ EOM's
maybe crepitus, telecanthus
CT, Abx, OMFS, admit
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16
Q

orbital floor blow out Fx

A

orbital floor fx
fat, blood into maxillary sinus
entrapment of ocular muscles (inferior rectus)

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17
Q

what you will see w/ entrapment of ocular muscles (inferior rectus)

A

diplopia on upward gaze
upward gaze deficit on EOM’s
30% have globe rupture

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18
Q

mngt of orbital floor blow out fx

A 
CT maxillo-facial & orbits (head)
check eye: vision, hyphema, pressures, subconjunctival heamtoma, subq emphysema
check infraorbital anesthesia
OMFS, ophtho consult
pain control, tetanus; admit?
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19
Q

retrobulbar hematoma

A

collection of blood behind the globe

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20
Q

retrobulbar hematoma d/t ?

A

trauma, post surgical

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21
Q

S&S of retrobulbar hematoma

A

proptosis

swelling

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22
Q

mgnt of retrobulbar hematoma

A

CT face/orbits, ULS
Abx, pain ctrl
ophtho consult, admit

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23
Q

red flags in retrobulbar hematoma

A 
vision loss
pupil irregular
papilledema
IOP up
field deficit= optic neuropathy
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24
Q

orbital compartment syndrome

A

swelling w/ optic neuropathy

lateral canthotomy to relieve pressure & save vision

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25
periorbital, orbital cellulitis
unilateral infxn around or around & behind orbital structures
26
S&S of periorbital, orbital cellulitis
fever, red, swelling EOM's painful proptosis if orbital
27
mgnt of periorbital, orbital cellulitis
CT orbits all, ULS useful periorbital: Abx, =/- admit orbital: serious, vision/life threatening; Abx (broad spectrum), ophtho consult, admit all
28
nasal fx's
``` prior nasal trauma, deformity? can you breathe thru your nose? blow nose= face swelling? clinical Dx-minor=no xray suspect NEO fx or other pathology- CT max/face/orbits ```
29
nasal-septal hematoma
check in nasal fx's | if present, must I&D or necrosis of septum ensues
30
mgnt of nasal fx's
reduction- specific cases only | ENT f/u 5-7 days after edema subsides
31
zygomatic arch
common, if isolated= less serious direct blow, swelling periorbital edema, subconj hemorrhage, flat cheek bone intraoral exam x-rays: get "bucket handle" view- depression? CT common: other fx's OMFS f/u- cosmesis
32
tripod fx
``` significant mechanism, facial swelling lateral subconjunctival hematoma infraorbital anesthesia check eye, lateral canthus down trismus consider head injury CT for Dx, OMFS consult, ophtho consult, admit ```
33
maxilla fx's
high-energy, midface, not subtle LeFort fx's intracranial injury common- CT head too
34
LeFort fx's
``` facture patterns often mixed check hard palate/upper teeth mobility CT, Abx, tetanus OMFS & ophtho consult admit for open reduction & fixation ```
35
LeFort fx 1
across maxilla
36
Lefort fx 2
across nasal bridge, under orbits
37
LeFort fx 3
goes thru orbits & nasal bridge
38
mandible fx's
``` open/closed? multiple fx's common tender, swelling, trismus, malocclusion, jaw, ecchymosis, bite test sublingual hematoma is pathognomonic panorex best ```
39
what is pathognomonic of mandible fx
sublingual hematoma
40
open mandible fx
blood in mouth gingival lacs teeth loose, separated or uneven
41
tx for open mandible fx
OMFS Abx tetanus admit
42
closed mandible fx magnt
outpt f/u
43
TMJ dislocation
jaw stuck open- post trauma, seizure or spontaneous | hx of same
44
unilateral TMJ dislocation
jaw away from side of dislocation
45
bilateral TMJ dislocation
protrudes forward
46
dx & mgnt of TMJ dislocation
``` x-rays if traumatic pain meds, anxiolytics, suction reduction: downward pressure, rock & pull forward- from above or from front of pt liquid diet for 3 days OMFS f/u ```
47
hearing loss
``` sudden or gradual? partial or total? unilateral or bilateral? trauma, recent infxn, meds (bilateral) conductive or sensorineural? ```
48
meds known for causing hearing loss
``` NSAIDS aminoglycosides erythromycin Lasix ASA antimalarials chemo ```
49
hearing loss assoc. sx's
``` tinnitus vertigo HA drainage pain ```
50
hearing loss PE
look in ear FIRST then look for tuning fork conductive loss is common look for cerumen, TM perf, OE, SOM, FB
51
Weber test
tuning fork on head conductive- heard best in affected ear sensorineural- heard best in good ear
52
Rinne test
mastoid then next to ear conductive- BC>AC sensorineural loss- AC>BC or can't hear it
53
cerumen impaction
may describe as fullness or "underwater" removal: manual-curette or irrigate w/ 18 g angiocath w/o needle, 1 part peroxide, 2 parts water, irrigate w/ 30cc syringe, immediate relief of sx's check TM after
54
uncomplicated otitis externa
inflammation of the outer ear & ear canal | inflammation of the skin of ear canal is essence of d/o
55
malignant otitis externa
``` osteomyelitis of ear canal elderly, DM, immunocomp unresponsive OE, pseudomonas painful, especially w/ movt of tragus conductive hearing loss +/- thick, granulation tissue in canal, +/- see TM, facial n. palsy or paralysis admit, IV anti-pseudomonals, ENT consult ```
56
fungal OE
chronic OE in DM, immunocompromised painful, white or black fuzzy d/c in canal suction out canal, antifungal/acetic acid
57
supprative perichondritis
auricle tender, warm, swollen- TM nml | IV Abx, ENT, consider admission
58
ear canal furuncle
painful, red, maybe pointing abscess | needle aspirate or I&D if possible; Abx, pain
59
FB in ear canal
insect: lidocaine drops- mosquito forceps kids: may need sedation irrigate if not organic (won't fall apart) check TM tx for otitis externa
60
otitis media
red, bulging TM, decreased mobility AMOXICILLIN still first line serous OM- "fullness", bubbles, TM not red decongestants
61
bullous myringitis
painful, clear or red blisters on TM URI common mycoplasma or viral- tx w/ macrolides
62
TM perforation causes
post-infxn blunt or penetrating trauma noise trauma barotrauma
63
S&S of TM perforation
``` painful hearing loss blood serous fluid or no d/c tinnitus vertigo common ```
64
TM perforation basics
up to 90% heal on own Weber lateralizes to affected side ear dry, NO drops, suspension ok refere to audiology, ENT
65
cholesteatoma
``` squamous epithelium mass behind TM acquired or congenital grows, erodes TM, ossicles CT if suspect, then MRI ENT for removal ```
66
possible S&S of cholesteatoma
hearing loss pain d/c neuro sx's= red flag
67
risks of cholesteatoma
chronic OM | perforations
68
auricular hematoma
post-traumatic, hematoma bet. skin & cartilage leads to necrosis if not tx: cauliflower ear incise edge, evacuate clot no suture dressing packed firmly into contours/ behind ear pressure dressing 24 hr f/u- check clot recurrence
69
auricle laceration
``` block the ear/local anesthesia suture thru skin, not cartilage, to close non-absorbable 6-0 best attempt to retain shape, contour do not debride too aggressively ```
70
Ramsay Hunt syndrome
herpes zoster of face w/ involvement of auricle & TM
71
Ramsay Hunt syndrome S&S
painful unilateral hearing loss peripheral facial paralysis or sensory loss
72
Tx of Ramsay Hunt syndrome
Acyclovir steroids pain meds 48 hr f/u aftter ENT consult
73
Check for corneal involvement in Ramsay Hunt syndrome
Hutchenson's sign (zoster lesions on tip of the nose)
74
mastoiditis
``` rare, serious, toxic pt complication of unresolved OM hearing loss, ear pain, tender fluctuant mastoid, TM red, +/- perf w/ d/c CT head w/o contrast IV Abx, ENT consult kids, toxic= admit ```
75
nasal furunculosis/cellulitis
infected hair follicle- usually Staph, cover MRSA
76
tx nasal furunculosis/ cellulitis
``` remove offending hair aspirate or I&D if localized, pointing Abx (MRSA) warm compress 24 hr f/u abscess of cartilage, ala, columella cellultis DM, immunocompromised-admit ```
77
options to remove nasal FB's
infants, little kids: parent occludes opposite nostril & blows into mouth vasoconstrict w/ neo-synephrine or Afrin mixed w/ lidocaine (careful w/ cocaine) blow after vasoconstricition alligator forceps, ear curette, Dermabond or small foley cath passed beyond object- inflate- pull out organic FB? irrigate gently saying "eng" check ears too no luck--->ENT
78
epistaxis
anterior or posterior? coumadin? trauma? 90% at Kiesselbach's plexus
79
mild-moderate bleeding in epistaxis
blow nose- get clots out | sit forward/pinch
80
epistaxis won't stop
gown, glasses, light, suction soak several Q-tips in 4% cocaine or Neo synephrine w/ 4% lido apply to nostril
81
Silver nitrate cautery stick
minimum, one side only | Abx oinment over site, saline nasal spray
82
Tampon packing
insert along floor of nasal cavity (lube w/ abx ointment) moisten after insertion-expands to space 24 hr f/u, Abx, saline drops
83
Rhino rocket
tampon alternative | mesh covered, inflate w/ saline
84
extra epistaxis tx
``` nasal balloon + ENT abx ointment for lube VS, monitor, tetanus 24 hr f/u, abx w/ Rhino rocket admit if posterior, massive, re-bleed moisten tampon prior to removal ```
85
sinusitis
``` unilateral, face pain purulent d/c teeth pain HA Sx's +/- 7 days ```
86
sinusitis caused mainly by?
viral
87
sinusitis mgnt
Abx if fever, hx of chronic decongestants CT over plain x-rays
88
Ellis I fx
enamel only no further tx dental referral
89
Ellis II fx
``` hot/cold/air sensitive see yellow dentin exposed cover w/ cement dental consult 24 hr f/u ```
90
Ellis III fx
pulp exposed- see blood dental consult now cover w/ cement or isolate tooth w/ moist, sterile gauze 24 hr f/u- discuss necrosis, tooth loss
91
concussion of tooth
painful but not loose, no ED tx, dental f/u
92
subluxation of tooth
loose push very loose back in- stabilize/splint PCN VK, dental f/u 24 hrs
93
avulsion of tooth
totally out < 15 min: gently clean tooth, socket- push back in 15 min- 2hrs: soak tooth, clean socket, replace 2 hrs- same w/ discussion no tooth? do a CXR to look for it can soak in milk
94
alveolar ridge fx
``` subluxed or avulsed teeth lift lip, check buccal space hematoma ridge moves w/ palpation panorex, CT IV Abx, pain ctrl OMFS consult ```
95
dental abscess or infxn S&S
facial edema pain tender tooth fever
96
tx dental abscess or infxn
I&D only if clearly pointing or buccal space is full, fluctuant dental referral 24 hrs PCN VK, pain meds, warm rinses
97
dry socket
painful necrosis socket | 2-4 days post extraction
98
dry socket tx
block the tooth, irrigate socket w/ warm NS gently pack socket w/ 1/4" plain packing guaze soaked in clove oil or dry socket paste dentist w/in 24 hrs
99
necrotizing ulcerative gingivitis (trench mouth)
``` fetid breath bleeding gums fever pain immunocomp "punched out" interdental papilla ```
100
tx trench mouth
flagyl (metronidazole) chlorhexidine rinse dental & PMD f/u for w/u
101
lip lacerations
does it cross the vermillion? approximate 1st, must line up thru & thru? irrigate, sew outer, irrigate again, sew mucosa use absorbable 4-0 for mucosa, non-absorbable 6-0 for lip & skin
102
oral mucosal lacs:
repair only large or flapping | the rest will heal
103
tongue lacerations
small, mid-tongue: ctrl bleed, ice, may not need sutures thru/thru, at edge, w/ flap, large lac: suture anesthesia: lingual n. block for anter. 2/3 tongue- at 2nd molar local lidocaine w/ epi alternative absorbable 4-0 suture, bury knot complex- consider layered closure
104
Sialolithiasis
``` salivary gland stones- obstruction common: Wharton's duct edema, pain, possible infxn see stone, try to massage out abx, lemon drops, analgesia, ENT f/u ```
105
sialoadenitis
mumps
106
Ludwig's Angina
bilateral cellulitis of submandibular space fever, painful edema under chin, trismus, dysphagia, dysphonia, tongue displaced, edema of floor of mouth, fullness, edema of submental space
107
Tx Ludwig's angina
CT is test of choice | ENT, admit, airway precautions, IV Abx
108
Uvulitis
sore throat FB sensation think allergy, angioedema
109
tx uvulitis
``` Abx for strep consider steroids pain meds slippery foods close f/u ```
110
peritonsilar abscess
``` sore throat "hot potato" voice trismus fever unilateral peritonsilar & soft palate redness, fluctuance uvular deviation AWAY from abscess cellulitis vs. abscess ```
111
tx peritonsilar abscess
ULS fo rfluid spray anesthesia then inject w/ lido w/ epi 18 g needle, 3 puncture sites beware "big red"
112
retropharyngeal abscess
neck pain (pain when look up dysphagia fever pharynx looks almost normal- pain & sx's out of proportion to exam
113
mngt of retropharyngeal abscess
soft tissue neck 1st ok: but CT of neck is diagnostic airway concerns ENT, IV Abx, admit
114
epiglottitis
no H. flu vaccine rapid onset, voice changes, positioning pharynx doesn't match soft tissue neck- portable if worried
115
epiglottitis mgnt
monitor, airway equipment | Abx, steroids, ENT
116
swallowed FB's
aspirated vs swallowed the fish bone FB sensation at rest, worse w/ swallowing
117
swallowed FB mgnt
``` laryngoscope fiber optic scope mirror soft tissue neck, CXR often abrasion only pulmonar to go fishing ```

Emergency Med Final (9 decks)

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