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Clin Med III > Exam 1 Emergency Med > Flashcards

Exam 1 Emergency Med Flashcards

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1
Q

Cauliflower ear (aka wrestlers or boxers ear) is what? if left untreated, may result in what?

A

= hematoma of the pinna usually due to blunt trauma

  • left untreated may result in cartilage necrosis, chronic scarring and deformity
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2
Q

Describe a laceration of the pinna. What do you need to check for and what repair option is best?

A
  • bleed a lot
  • watch for hematomas, be sure no injury to internal ear
  • if laceration needs to be repaired, RUNNING SUTURE
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3
Q

What is often the cause of perichondritis (inflammation of the cartilage) and how does it present

A

Ear piercing, particularly to upper 1/3 of pinna can result in ear infection

Pain, erythema, warmth

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4
Q

What should you be aware of with perichondritis, specifically with the type and location of the infection?

A

upper 1/3 pinna cartilage is avascular, improper healing predisposes to PSEUDOMONAS and STAPH AUREUS infections that can spread rapidly and lead to deformity

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5
Q

If pt develops perichondritis infection (ie staph aureus or pseudomonas) what tx is recommended?

A

ABX and surgical debridement

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6
Q

What is MOE, pathogen, sx?

A

invasive infection involving temporal bone often seen in immunocompromised pt

Primary path: PSEUDOMONAS
*severe pain worse at night, purulent otorrhea, trismus, CN 7,8 palsies, edematous and erythematous ear canal with granulation tissue

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7
Q

Sx of MOE

A 
ear pain worse at night
purulent otorrhea
trismus
CN palsies
ear canal edematous and erythematous with granulation tissue
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8
Q

How do you dx MOE

A

CT

*need to r/o temporal bone involvement

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9
Q

How do you treat MOE

A

ENT referral

  • admission
  • IV abx: imipenem, cipro or ceftazidime
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10
Q

what is mastoiditis/what causes it? sx?

A

Extension of OE or AOM into mastoid air cells (suspect mastoiditis if slow resolution of OE or AOM sx)
*mastoid tenderness w/ edema and erythema, deep temporal pain

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11
Q

How do you dx mastoiditis

A

expect if slow resolution of OE or AOM

  • plain xray: density in mastoid air space (won’t see until 2 wk after onset)
  • CT BEST DX STUDY
  • tympanocentesis for fluid to culture
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12
Q

how do you treat mastoiditis

A 
Hospitalize
IV abx (Vancomycin: G+, or Nafcillin/Oxacillin: MSSA coverage, antistaph)

mastoidectomy required if complications, ie no response to IV abx

prognosis is good

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13
Q

Epistaxis causes

A 
most common: trauma
- FB
- iriitants (cigarette smoke)
Meds (aspirin, NSAIDS, anti-coag)
- digital trauma
- Hem disorders: hemophilia, leukemia, plt dysfunction, thrombocytopenia
- HTN
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14
Q

How should you initially treat epistaxis

A

have pt sit with head forward, direct pressure for 5 min

  • ensure hemodynamic stability, and airway patency
  • STOP bleeding, keep airway patent
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15
Q

what are silver nitrate sticks used for

A

cauterizing

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16
Q

where does epistaxis typ occur in children?

A

anteriorly on the nasal septum

  • branch of labial artery
  • kiesselbachs
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17
Q

Where does epistaxis typ occur in adults? elderly?

A

adults: Septum, posterior

Elderly: hard to id/control, branch of MAXILLARY a, posterior, more bleeding and systemic factors

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18
Q

How do you treat and anterior nose bleed

A

Topical vasoconstrictors

  • 2% neo-synephrine spray (a agonist)
  • 4% cocaine spray/sol on cotton pledgets

Cautery

  • chemical (silver nitrate)
  • hemostatic packing material: Gelfoam, Surgicel
  • Electrocautery (specialist)

Anterior packing
- petrolatum-impreg gauze packed in anterior nares with forceps, leave 48 hr

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19
Q

what topical vasoconstrictors are there for epistaxis tx

A

2% neo-synephrine spray (alpha agonist)

4% COCAINE spray/sol on cotton pledget

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20
Q

What types of cautery tx options are there for bleeds

A

chemical (silver nitrate)
Hemostatic packing material (Gelfoam or Surgicel)
Electrocautery (specialist)

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21
Q

What is anterior packing? how long is it left?

A

epistaxis tx option involving petrolatum-impreg gauze packed into the anterior nares with forceps; leave 48hr!!!

Or can use preformed nasal tampon

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22
Q

How do you treat Posterior nose bleeds

A

Vasoconstrictor: pledgets sat in 4-5% cocaine or 2% neo-synephrine

Anterior packing

Posterior packing: post pack + ant nares bilat; balloon cath (leave 2-5d), hospitalize if post pack or balloon catheter

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23
Q

how long is a balloon catheter left in

A

2-5 days

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24
Q

What are complications of posterior bleed tx

A

Septal hematoma, sinusitis, toxic shock syndrome

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25
Nasal fx sx tx? concerns?
common injury usually from blunt trauma, usually associated epistaxis (eval fo septal hematoma) * non displace gen don't need immediate intervention, ENT ref w/in 3-5d * blood with surrounding straw colored serous fluid, think other facial fx (ie cribiform plate), need urgent neurosurgical consult
26
how do you treat nasal fx surgically?
rhinoplasty
27
Why do septal hematomas occur? sx?
seen after trauma, more freq in peds pt sx: increase nasal obstruction, pain & tenderness PE: soft, tender swelling
28
Why is it so important to fix septal hematomas
if not fixed, septal hematoma is risk for avascular necrosis or saddle nose deformity
29
How do you treat septal hematomas?
incision, drainage of hematoma to prevent avascular necrosis | *following drainage, pack nose & ABX
30
When do you refer to ENT for FB removal
after 2 unsuccessful attempts (ie suction, irrigation, retrieval w/ alligator forceps) *if remove one FB, look for a second
31
What potentially life threatening complications can result from sinusitis and why?
result from extension of bacterial infection into orbital or intracranial spaces (can be viral or bacterial: H flue, strep pneumo, moraxella) 1. Periorbital cellulitis 2. Orbital cellulitis 3. Cavernous sinus thrombosis 4. Frontal osteomyelitis
32
What is periorbital cellulitis? Cause?
infection confined to the eyelids (s. pneumo, s. aureus), may be complication of sinusitis or local disruption of skin (ddx: trauma, contact allergy, dacrocystitis)
33
s/sx of Periorbital Cellulitis, PE assessment?
unilateraly periorbital edema with erythema, tenderness, fever PE: assess visual acuity, EOM *vision loss, diplopia, proptosis = intraorbital involvement consistent with ORBITAL cellulitis
34
on eye PE, if vision loss, diplopia, and proptosis, what should we fear
orbital cellulitis
35
What is the most helpful study for dx of periorbital /orbital cellulitis
CT scan will distinguish bw perioorbital and orbital cellulitis
36
how do you treat periorbital cellulitis
hospitalize anyone who is febrile and appears acutely ill IV ABX consult ophthalmologist and/or ENT *prognosis good if tx started early
37
What is orbital cellulitis and what can it cause
TRUE EMERGENCY; can lead to vision loss, meningitis, cavernous sinus thrombosis, frontal abscess *periorbital edema, erythema, proptosis, chemosis (inflammation of conjunctiva), impaired EOM, vision loss, diplopia
38
How should you treat orbital cellulitis
true emergency need to admit for IV abx NAFCILLIN + CEFTRIAXONE + METRO IV
39
What is cavernous sinus thrombosis? Cause? sx?
acute dev of sx following infection (orbital cellulitis) * severe unilateral, retro-orbital HA * bilateral proptosis * ophthalmoplegia * vision loss * sensory dysfunction (hypo/hyperesthesia of CN V, 1st branch, ophthalmic branch) - - very sensitive or not sensitive at all
40
Cavernous sinus thrombosis PE findings
* febrile, toxic appearing pt * periorbital edema * CN dysfunction (III, IV, VI) * Papilledema (late): blurring of optic disc margins due to increased intracranial pressure - Need urgent heat CT, IV abx (vancomycin, ceftriaxone)
41
how should you treat cavernous sinus thrombosis
Need urgent head CT | IV abx: Vancomycin, Ceftriaxone (Rocephin IM)
42
Frontal Osteomyelitis.. what is it? cause?
aka pott's puffy tumor (infection of frontal bone --> progressive swelling of forehead) due to complication associated with frontal sinusitis *most commonly S. aureus and anaerobes
43
Pt recently was dx with frontal sinusitis and now present to the office with HA and progressive swelling of the forehead.. what is your suspected ddx? how do you confirm? tx?
suspect frontal osteomyelitis dx: CT or MRI is dx tx: drain abscess, debridement of infected bone, IV Abx Vanco or Nafcillin (G+ and some G-)
44
PE findings, Cavernous Sinus thrombosis.. actions to take?
febrile, toxic appearance, CN dysfunction (III, IV, VI), periorbital edema, papilledema (late) *need urgent heat CT, IV Abx (vanco, ceftriaxone)
45
Cause frontal osteomyelitis
complication of frontal sinusitis (often S aureus and anaerobes)
46
Cause of tongue laceration? risks? tx?
usually related to injury (teeth) * great potential for infection and hematoma tx: usually not sutured unless more than 1/3 width of tongue or tip of tongue involved (use absorbable sutures and give abx)
47
Cause, outcomes, tx puncture wounds in mouth
common, rarely serious, often due to running with something in mouth, almost always small * bleeding resolves spontaneously, start abx if necessary * rinse with warm water after every meal, topical anesthesia for pain control (Orabase dental paste or solution or maalow and liquid benadryl)
48
Topical anesthesia for puncture wounds?
for pain control Orabase dental paste to prevent irritation Solution of maalox and liquid benadryl soluation 1:1
49
What typically presents with uvula displacement
Peritonsillar abscess (need to drain but watch out for carotid artery located behind abscess, give abx)
50
Ludwigs Angina: what is it? cause?
infection involving the submandibular space; 85% result of dental infection but can also see with peritonsillar abscess, oral malignancy or mandibular fx rapidly progressive infection associated with neck swelling, tongue protrusion, pain; also fever, malaise, trismus and halitosis
51
Ludwigs angina can be seen with what other conditions
dental infection peritonsillar abscess oral malignancy mandibular fx
52
common pathogens of Ludwigs angina infection of submandibular space?
Streptococcus staphylococcus, bacteroides
53
Spread of Ludwigs Angina infection of submandibular space can
compromise oral cavity, airway, deep neck spaces
54
Sx of Ludwigs angina include
``` neck swelling tongue protrusion pain fever, malaise trismus halitosis ```
55
Tx of ludwigs angina
ENT consult for potential airway compromise, surgical debridement, IV ABX
56
What is a peritonsillar abscess and sx?
Most common abscess of the head sx: fever, severe sore throat, drooling, odynophagia, otalgia, "hot potato" voice signs: trismus, UNILATERAL erythema, swelling, UVULA DISPLACEMENT
57
keep features peritonsillar abscess
UNILATERAL erythema, uvula displacement
58
tx for peritonsillar abscess
drain abscess, abx
59
What is sialoadenitis? cause?
inflammation of any salivary glands (parotid, submandibular, sublingual) *Viral or bacterial etiology *suppurative most commonly caused by Staph aureus Obstructive from stone or calculus in salivary gland or duct
60
Who typically has sialoadenitis
elderly, DM, poor oral hygiene, dehydration
61
sx of Sialoadenitis (inflam of salivary gland)
enlarged swollen, painful mass with stone, may complain of xerostomia (dry mouth); pain worse during mealtime VIRAL = BIlateral bacterial = UNilateral
62
other ddx of sialoadenitis?
also concerned LAD strep throat Mono wt loss and painful cervical LAD worry about Hodgkins Lymphoma
63
How do you treat Sialoadenitis?
if supporative (usually due to S aureus pathogen) --> anx such as nafcillin * rehydration, proper oral hygiene * surg irrigation, drainage * if obstructive etiology: most stones will pass spontaneously; lozenges to stimulate salivary secretion
64
what lab value will be elevated with Sialoadenitis
serum amylase (bc inflammation of parotid gland)

Clin Med III (5 decks)

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