ENT Emergencies
Terms
undefined, object
copy deck
- Define cauliflower ear
- thickening of the external ear resulting from trauma
- Define epistaxis
- bloody nose
- Define tinnitus
- a subjective ringing, buzzing, tinkling or hissing sound in teh ear
- Define vertigo
- the sensation of moving around in space
- Define subjective vertigo
- sensation of moving around in space
- Define objective vertigo
- having objects move about the person
- Define saddle nose deformity
- a marked depression of the bridge of the nose, commonly seen with congenital syphillis disease
- Understand the potential complications of local anesthesia in the pina
- direct infiltration of the pina should be avoided due to risk of tissue necrosis
- Understand the potential complications of local anesthesia in the nose
- block of the infra-orbital nerve alone will not provide adequate anesthesia alone, mucosal surface must be anesthetized by topical application
- Know what disfiguring complications can occur in lacerations or injuries to the ears
- Epi should be avoided. Hematoma of the auricle should be referred to plastics. No cartilage should bve removed and debridement is not advisable
- Know what disfiguring complications can occur in lacerations or injuries to the nose
- the most important assessment of nasal lacerations is to determine their depth and involvement into deeper tissue layers.
- Know what disfiguring complications can occur in lacerations or injuries to the ears eyebrow
- never clip or shave eyebrow as it is used as landmarks for repair. It is also unlikey it will grow back in the same pattern as before injury. A scalple must clean edges and cut parallel to hair follicles to minimize alopecia
- What is the significance of clear otorrhea in the setting of head trauma
- indicates CSF drainage, use halo test. These pt's are at risk for post injury meningitis. High index of suspicion for Spinal injury
- Describe the typeof injury likely to cause a perforated eardrum and PE
- YM perfs can occur as result of blunt, penetrating or noise trauma. When secondary to this, the perf almost always occurs in teh pars tensa usually anteriorly or inferiorly.
- ENT Emergencies
- ENT Emergencies
- Describe how to remove a live insect or other FB from the external auditory canal
- drown insect with 2% lido or viscous lido to paralyze bug. Suction out with butterfly tubing and remove insect with gentle suction or forceps under direct visualization.
- Identify sites of epistaxis and compare which is more common as well as which is more likely to be severe
- Blood supply of nasal mucosa originates from carotid arteries. Acute epistaxis is potentially serious. Most cases are self-limiting and can be managed conservatively
- Define anterior epistaxis
- represents 90% of nosebleeds, most originate from Kiesselbach plexus. AKA picking zone, most prone to drying and cracking from environment.
- Define posterior epistaxis
- less common. More common in elderly dut to arteriosclerosis. Most common site is posterior to inferior turbinate, posterior to vestibule and emanates from branches of sphenopalatine artery. More difficult to control.
- Understand the methods for treating anterior epistaxis.
- direct pressure, vasoconstrictive agents, nasal packing and cautery.
- When is direct pressure indicated for epistaxis
- Most anterior epistaxis. Compress the elastic areas of the nose between the thumb and middle phalanx of index finger
- When is vasoconstrictive agents indicated for epistaxis
- use in conjuction with all other tx modalities and should be instilled into the nose before pressure. Have pt blow out nose prior to remove any clots to ensure that medication reaches the nasal mucosa
- When is cauterizing indicated for epistaxis
- after bleeding has stopped. Tip of silver nitrate stick is gently and briefly applied to bleeding site. Chemical cautery can lead to septal perforation. Electrical and thermal cautery is best left for otolaryngologist
- When is nasal packing indicated for epistaxis
- anterior nasal packing when direct pressure, vasocontrictors, cauterizing fails. For posterior nasal packing use commercial devices.
- What are the potential complications of nasal packing
- any pt who has undergone nasal packing may be considered for prophylaxis against staphylococcal infections and for sinusitis
- Explain why x-ray is not usally necessary when evaluating a potential nasal fracture
- they do not determine need for intervention and do not affect surgical planning.
- What associated injuryies or complications need to be considered in a pt with a nasal fx
- nasal deformity, deviated septum, septal hematoma, cribiform plate fx and associated facial, head or spinal injuries
- Explain what a septal hematoma is, when to look for it and know its most significant complication
- Collection of blood beneath the septal perichondrium. Appears bluish, fluid filled sac overlying septum. Manage by making an incision for drainage and packing to prevent reaccumulation
- Explain sequence of events that can result from a septal (subchondral) hematoma
- abscess or avascular necrosis (AVN) of cartilaginous septum. AVN is associated with cosmetic complications of saddle nose, retraction and changes in phonation
- What are organisms, Sx's and Tx for external ear infections
- Org: staph, pseudo or fungi. Sx: px, itching, fever, exudate, edema. Tx: earwick, cortisporin, domeboro
- What are organisms, Sx's and Tx for middle ear infections
- Org: strep, H.flu, M.cat. Sx: fever, px in face/neck/teeth, URI sx's, adenopathy. Tx: amoxicillin, deptra, pediazole
- What is Tx for ear hematoma
- cartilage becomes necrotic, can cause cauliflower ear. Open and drain, dress with NON-pressure dressing!
- What do you use to suture facial lacerations
-
Ethilon or prolene:
4.0 on eyes 4.0-5.0 on face 5.0-6.0 on nose and ears - What do you use to suture full thickness nasal lacerations
- 5.0 monofilament (ethilon) to line up and anchor. 5.0 absorbable to close mucosa. 6.0 monofilament to close using a mattress suture
- What is a peritonsillar abscess
- accumulation of purulent material between the tonsillar capsule and superior constrictor muscle of the pharynx. Possible complication of tonsillitis commonly in teens and early 20's.
- What are Sx's of a peritonsillar abscess
- ever, malaise, dysphagia, ST, otalgia, rancid breath, dehydration, unilateral tonsillar hypertrophy, contralateral deflection of swollen uvula, etc.
- What is the Tx for a peritonsillar abscess
- aspiration of pus - gold standard of Dx. IV hydration/ABX, px mgt, possible I&D
- What is a retropharyngeal abscess
- infection of deep neck spaces resulting from suppuration and necrosis of lymph nodes. Occurs in connective tissue pocket extending from base skull to level of tracheal bifurcation. Uncommon. Pt's usually under 12 mo old.
- What are predisposing factors and tx for retropharyngeal abscesses
- penetrating FB (NG/ET tube), trauma, pharyngitis/tonsillitis, OM. Immediate ENT consult and admission. ABX.
-
What is a LeFort I Fx -
Transverse fx thru floor of maxillary sinuses -
What is a LaFort II Fx -
thru maxillary sinuses (pyramidal fx) -
What is a LeFort III Fx -
Thru orbits (craniofacial dysjunction) - What are the 2 most common types of maxillofacial trauma
- 1st: nasal fx's. 2nd: mandibular fx's.
- What are the 2 MOA's for mandibular fx's
- 1. assaults 2. falls on chin. often multipel fx's and have a "ring" shape. Don't need imaging to dx
- What else should you look for with a LeFort type Fx
- spinal, cranial, thoracic and abd injuries
- How would you differentiate a posterior vs anterior nasal epistaxis
- Posterior: visualize blood from both nares. Anterior: visualize blood from ONE nare.
- What is more common: anterior or posterior expistaxis
- 90% are anterior