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EM ENT Emergencies
| Question | Answer |
|---|---|
| Auricular Hematoma | Physical trauma to the auricle which causes shearing of the tissues and a perichondral hematom. The auricle will be very swollen |
| Tx of Auricular Hematoma | Treat with I&D, then bolster both sides with dental roles. Failure to tx early leads to permanent remodeling of the auricle: cauliflower ear |
| Auricular Abscess | Can occur in embryonic pits. Can be cystic which then becomes infected. May also present as a perichondral abscess. |
| Tx of Auricular Abscess | Treat with I&D and may empirically treat with antibiotics which cover GP organisms. Culture will help focus antibiotic course if no improvement. If recurrent infxn occurs, will need to take to OR for excision of the cyst |
| Auricular Laceration | I&D. Excise any protruding cartilage. Approximate the wound and use interrupted sutures. Cover with abx |
| EAC Emergencies | FB, EAC insect, otitis Externa, Malignant Otitis Externa |
| FB in Ear Canal | If completely obstructing EAC, if TM perf present, or if touching the TM, consult ENT. Do not attempt to remove batteries (have acid and can leak and burn the ear drum) |
| Acute Bacterial OE | Remove debris, Place otowick if canal is too narrow, topical abx drops (not oral) |
| Acute Fungal OE | Very itchy, can look like bacterial infxn, suspect if abx fail to resolve the problem. Culture if fungus is suspected. Greenish-gray mushroom appearance. Tx with Aceptic acid drops |
| Malignant OE | chronically draining ear, DM, culture shows Pseudomonas aueruginosa. (temporal bone osteomyelitis). Needs non-contrast CT temporal bone and/or bone scan. ENT consult and IV abx |
| TM/Middle Ear Emergencies | TM perf, OME, Barotrauma, AOM, Acute mastoiditis, Acute Myringitis |
| TM perforation | Usually posterior. red-acute. non-red: not acute. Get audiogram. Put on non-toxic ear drops (floxin, Ciprodex). Keep ear dry. recheck hearing in 1-2 months. |
| Amber with fluid line may be | Otitis media with effusion. |
| Sx of otitis media with effusion | hearing loss, ear fullness, tinnitus |
| Rapid pressure changes cause negative pressure in the middle ear resulting in effusion and ruptured blood vessels. | Baratrauma. Tx with nasal steroids and time; generally will resolve. Audiogram will help determine if any significant hearing loss occurred |
| Acute OM | Ear pain, hearing loss, tinnitus, ear fullness |
| Acute mastoiditis | Complication of OM and is defined as spread of infection to the mastoid air cells Physical exam findings include fever, otalgia, post auricular erythema, swelling, and tenderness with protrusion of the auricle. |
| Which structure connects the mastoid and middle ear? | antrum. |
| Acute Mastoiditis Tx | Treatment includes IV abx, ENT consult, admission for observation and often mastoidectomy |
| Bullous Myringitis | Very painful, especially when coughin, sneezing. Likely caused by Mycoplamsa, H. flu, or Strep pneumo. Tx with abx and topical abx if vesicles rupture. pain management appropriate |
| Lower part of face innervated from | contralateral side. |
| Inner ear emergencies | Bell's Palsy, Sudden SNHL, Vertigo |
| Bell's Palsy Etiology: unknown, but thought to be inflammation of CN VII. Possibly HSV. Sx | Abrupt onset of upper and lower facial paresis or paralysis, mastoid pain, hyperacusis, dry eyes, altered taste. |
| SNHL | usually no warning, some pts hear a pop. 30dB loss in 3 frequencies. Refer to ENT stat, treat with steroids. Possible causes: Viral labyrinthitis, Autoimmune, Vascular compromise. Needs MRI of IAC with contrast |
| Provoked by supine head movements to the right or left | BPPV. Positive Dix-Hallpike maneuver. Treat with Epley maneuvers |
| Meniere's Dz | increased endolymphatic fluid, roaring tinnitus, vertigo, Episodic SNHL. Low frequency, usually unilateral. Tx: diuretics, low sodium, anti-vertigo meds, surgery. |
| Severe Vertigo lasting 24-48 hours, followed by several weeks of imbalance | Vestibular Neuonitis/Labyrinthitis |
| lasts seconds, head movements, no hearing loss | BPPV |
| lasts several hours, associated hearing loss, tinnitus, ear fullness | Meniere's |
| Severe disabling vertigo lasts 1-2 days, gradual recovery | Neuritis/Labyrinthitis |
| Nasal Emergencies | FB, Acute Sinusitis, Epistaxis |
| Consider ______if patient has foul nasal odor, chronic nasal discharge, nasal obstruction, sinusitis | Fb. remove and give abx. f/u to make sure there is no septal perf. |
| Signs and sx of Acute sinusitis | localized facial pain, upper tooth pain, purulent nasal discharge, fever, cough, fatigue may be present, facial pain upon percussion |
| Causative agents of acute sinusitis | Strep. pneumo, H. Flu, M. cat. Staph aureus. tx for 10-14 days |
| Anterior plexus involved in epistaxis | Kiesselbach's |
| Posterior plexus involved in epistaxis | Woodruff's |
| Systemic causes of Epistaxis | Clotting disorder, HTN, leukemia, liver dz, medication, Thrombocytopenia |
| Epistaxis | forward flex, manual compression, afrin, cautery, anterior, posterior packing, surgical |
| Acute necrotizing ulcerative gingivitis is associated with ___ infection | HIV |
| Cause of Angioedema | Can be a result of hereditary C1 esterase inhibitor deficiency, allergic reaction, ACE inhibitor therapy, or may be idiopathic |
| Tx for angioedema | Treatment should include benadryl, steroids, and epinephrine if airway compromise is imminent or the symptoms are rapidly progressing |
| Viral Pharyngitis lasts | <5 days, sore throat, nasal congestion, cough, fever. |
| Exudative tonsillitis may be | viral or bacterial. Can tx with abx. Treat with gram positive coverage: Amox, EES, Quinolones, bactrim |
| "Hot potato" voice is associated with | Peritonsillar abscess. Severe throat pain and dysphagia, inability to open jaw, assymetric swelling, copious salivation. REQUIRES I&D and ABX |
| Parapharyngeal abscess sx: | nuchal rigidity, stridor, sore throat, drooling. Potential AEs: mediastinal infxn, airway obstruction, epidural abscess, necrotizing fascitis, sepsis, erosion into carotid artery, jugular venous thrombosis |
| Ludwig's Angina | serious, potentially life-threatening cellulitis[1] infection of the tissues of the floor of the mouth, usually occurring in adults with concomitant dental infections. Usually raising of the tongue is seen |
| Seal-like cough, stridor in children. Steeple sign | Croup. Viral. Tx glucocorticoids, nebulized epinephrine |
| Thumb sign seen on lateral neck x-ray | Epiglottitis. Most commonly seen in adults due to childhood vaccination against H. flu vaccine |
| Tx of airway obstruction that is not easily removable | tracheostomy |
| Most common mandibular dislocation | anterior dislocation. Sx: jaw pain, trismus (can't open mouth completely), malocclusion |
| Tx for displaced mandibular fx | ORIF. |
| Fx across maxilla | Lefort I |
| Breakage of orbital bones transversely | LeFort III |
| Fx up over zygomatic arch | LeFort II |
| Most common cause of nose fx | blunt trauma |
| In nose fx, reduce if injury less than ___ hours | 3. otherwise, allow inflammation to decrease over a week. |
| Imaging for temporal bone fracture | Non-contrast CT of the temporal bone. ENT consult! |
| Sensorineural loss Weber test | Sound goes away from the affected ear |
| BPPV | Benign Paroxysmal Positional Vertigo |
Created by:
ltm12