OFFICE PROCEDURES Flashcards
1
Q
Presentation of foreign body in nose
A
- Witness on first day
- Delayed: unilateral purulent nasal discharge!
2
Q
Techniques for removal of foreign body in nose
A
- Suction: aspirate w/catheter
- Blow it out: positive pressure
- Pluck it out: ENT tools or use skin adhesive
- Rinse it out: nasal irrigation
- Pull it out: catheter method
3
Q
Preparing patient for removal of foreign body in nose: suction method
A
- Tools & support straff ready
- Pretreat w/vasoconstrictor (shrink swelling)
- Position in sniffing position! (won’t go to airway)
4
Q
Positive pressure methods for removal of foreign body in nose
A
Parent’s kiss (plug other side of nose, blow into mouth)
- Bag valve mask over mouth
- Beamsley Blaster: tool to use highflow O2 to push out
5
Q
Pulling: method for removal of foreign body in nose
A
- Secure child’s head
- Place balloon catheter in affected nare
- Insert past the FB and inflate balloon
- Withdraw balloon slowly, pulling FB out of dilated nare
- *good if space to get by!
6
Q
Nasal wash method for removal of foreign body in nose
A
- Fill blue bulb syringe w/saline
- Tilt patient’s head forward over basin and make a good seal
- Instill saline into opposite nare
- Flush out FB from affected nare alone w/saline
- *esp good if organic matter – multiple pieces!
7
Q
What to do after removal of foreign body in nose
A
Take a 2nd look! – second foreign body, trauma or underlying infection
8
Q
When to refer to ENT for foreign body in nose
A
- Multiple failed attempts
- Pts who require sedation
- Trauma to nose
9
Q
Risks to foreign body in ear
A
- Trauma to ear canal or rupture of TM
- Infection
- Insects!
10
Q
When to refer for foreign body in ear
A
- Object too close to TM
- Sedation required
11
Q
How to remove insect from ear
A
- Anesthetize ear!
- Instill lidocaine –> drowns insect –> remove
- Scoop out w/forces, curette, or swab
- Flush out w/saline (similar to cerumen)
- Pluck out (skin adhesive)
12
Q
What to do after removal of foreign body from ear
A
- Second look! FB, trauma, infection
- Consider otic antibiotics: Cipro or ofloxacin drops 5-7days
13
Q
Alarm signs for nail injury
A
Fracture and laceration at fingertip (osteomyelitis)
14
Q
Presentation of subungual hematoma
A
- After crushing injury
- Bluish discoloration beneath nail
15
Q
Mgmt of subungual hematoma
A
- Trephination: Drain hematoma if >25% of nail bed (pressure) and 1st 24h of injury.
- Do not drain if old organized clot
16
Q
How to drain subungual hematoma
A
- Cautery or 18 gauge needle
- Prep w/betadine. Dry completely, hand on hard surface. Apply cautery or needle directly to nail. Stop once through nail. Evacuate by soaking or gentle pressure.
- No need to anesthetize w/cautery
17
Q
Presentation and cause of paronychia
A
- Superficial infection around nail
- Painful swollen epinychial fold
- Caused by staph or strep (anaerobes in thumb suckers)
- (may be caused by ingrown nail)
18
Q
Tx for paronychia
A
- Mild: warm soaks
- Moderate: I&D
- Severe: I&D, oral antibiotics
19
Q
How to drain paronychia
A
- Anesthetize w/digital block
- Elevate nail fold w/scalpel
- Release pus
- Do not directly incise skin!! Needs to come through skin, not ideal
20
Q
Mgmt of ingrown nail
A
- Need to tx or infection will occur
- Can ask pt to elevate nail ledge (cotton)
- Or can resect nail wedge
21
Q
How to assess for eye injury
A
- Examine external eye, lids, sclera, conjunctiva, pupil, palpate bony landmarks
- Flip lid to examine for FB
- Check red reflex, pupillary responses
- EOMs and acuity
- Check for corneal abrasion
22
Q
When to refer for eye injury
A
- Bony fracture palpated, pain on eye mvmt, suspect puncture
- (always check acuity when sending to optho!)
- Deep or large abrasion, abrasion in direct line of site
23
Q
Presenting Sx of corneal abrasion
A
Tearing, painful eye, photophobia
24
Q
Causes of corneal abrasion
A
- Debris, injury from fingernail, contact lens
- Neuropathy from Bell’s palsy (dry eyes)
25
Assessing for corneal abrasion
* Position supine
* Anesthetize w/proparicaine
* Fluoroscein stripor drops
* Apply to nasal aspect of eye
* Lights up green w/wood’s lamp
* Pooling is normal
* Do not use if suspect globe rupture!
26
Tx for corneal abrasion
* No patching (impedes healing)
* No numbing!
* Rx for antibiotic ointment
27
DDx for corneal abrasion
Always be alert for HSV!!
28
Factors to assess for in burns
* Method, severity, extent
* Assess for associated injuries
29
Methods of burn
* Light: intense light, UV
* Chemical: acids, bases, caustics
* Thermal: flame, steam, not liquids
* Electrical: current, lightening
* Radation: nuclear sources
30
Severity of burns
* 1st degree: red painful skin, like a sunburn, heals in 2-3 days w/no scar
* Superficial partial thickness: red w/wet painful blisters. Heals 2 wks w/minimal scarring
* Deep partial thickness: thrombosed vessels give speckled look, more scarring
* Full thickness: pale charred leathery skin, not as painful w/nerves damaged
31
When to refer to burn center
Any full thickness burn! Emergency eval for burn center admission.
32
How to calculate extent of burn
* Calculate BSA involved
* Adults: rule of 9s
* Children: Patient’s palms= 1% and add it up
33
What to do in case of burn / triage
* Stop burning – remove clothing
* Cool skin (avoid direct ice)
* Keep blisters intact
* Apply antibiotic ointment
* Refer as needed
34
Wound care for first degree burns
NSAIDs
35
Wound care for 2nd degree burns
Clean w/soap/water, debride dead tissue, apply ointment, cover w/gauze
36
Wound care for 3rd degree burns
Cover and transfer to hospital
37
Home care instructions for burns
* Change bandage every day
* Wash w/soap and water
* Check for infection
* Re-apply ointment
* Return for infection or debridement
38
Burns: When to admit to hospital
* 2nd and 3rd degree burns w/ \>10% BSA
* Involves hands/feet, face, circumferential around joints, perineum
* Associated injuries (inhalation, chemicals)
* Concerns for abuse/neglect
39
When to use tissue adhesives
* Cyanoacrylate
* Great for wound closures!
* NOT for high tension areas (chin, fingers), highly contaminated wounds (bites), densely hairy areas (scalp)
40
How to apply tissue adhesive
* Position to avoid dripping!
* Clean wound and dry before closure
* Reduce tension on wound, pull together to approximate
* 1-2 layers
* No bandage, no ointment
* \*petroleum to create barrier to eye. Petroleum can also be used to remove if drips!
41
Who gets nursemaid’s elbow?
Toddlers! Subluxed radial head
42
Assessment for nursemaid’s elbow
* Examine arm for swelling, crepitus, deformity
* If not present --\> reduce arm
* Not in pain though may be apprehensive and guard arm
43
Methods to reduce nursemaid’s elbow
* Hyperpronation: position arm slightly extended, grasp elbow with one arm, grasp patient hand w/other, rotate to pronate hand until thumb pointing to floor
* Supination/flexion: position arm at 90 degree angle, grasp elbow w/non-dominant hand, rotate palm up and flex at elbow
44
Education w/nursemaid’s
* At risk for repeats!
* Don’t swing by hand!
45
How to use slings and splints
* Immobilize above and below injury (e.g., forearm injury – if you don’t immobilize elbow, can supinate and pronate)
* Extra padding in pre-verbal kids
* Leave fingers exposed for assessment of circulation
* Immobile position should be functional
* Close f/u!
46
How to make a splint functional
* Upper extremity needs to be elbow flexed, wrist extended, fingers flexed
* Lower extremity: knee extended, ankle 90 degrees
47
When to refer when requiring sling/splint
* Angulation or deformity
* Sensory changes or nerve injury (hours after injury)
* Pain persists after 1 week
