ent emergencies
DESCRIPTION
ENT Emergencies. Sonbolestan m.d otorhynolaryngologist. THE EAR. Perichondrial Haematoma. Rx : Systemic antibiotics Analgesia URGENT REFERRAL for incision & drainage. Cauliflower Ear. Perichondrial Cellulitis. Rx : Systemic antibiotics Analgesia - PowerPoint PPT PresentationTRANSCRIPT
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ENT EmergenciesENT Emergencies
Sonbolestan m.dotorhynolaryngologist
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THE EARTHE EAR
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Perichondrial HaematomaPerichondrial Haematoma
Rx : Systemic antibiotics
Analgesia
URGENT REFERRAL for incision & drainage
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Cauliflower EarCauliflower Ear
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Perichondrial CellulitisPerichondrial Cellulitis
Rx : Systemic antibiotics
Analgesia
REFERRAL to ENT if no response after 24hr
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Otitis Externa - FeaturesOtitis Externa - Features Discharge, pain, hearing loss, Discharge, pain, hearing loss,
itchingitching Commonest organisms:Commonest organisms:
S AureusS Aureus Ps AeruginosaPs Aeruginosa ProteusProteus
Predisposing factors:Predisposing factors: WaterWater Cotton budsCotton buds EczemaEczema
Treatment:Treatment: Topical antibioticsTopical antibiotics Aural toiletAural toilet AnalgesiaAnalgesia
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Otitis Externa - VariantsOtitis Externa - Variants
Fungal Malignant OE- Diabetes- VII palsy
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Malignant Otitis ExternaMalignant Otitis Externa
Risk factor – DiabetesRisk factor – Diabetes Granulomatous polypoid otitis externaGranulomatous polypoid otitis externa Disproportionately severe painDisproportionately severe pain Associated features:Associated features:
Cranial nerve involvement – VII, IX, X, XI, XIICranial nerve involvement – VII, IX, X, XI, XII Treatment:Treatment:
Topical antibiotics and aural toiletTopical antibiotics and aural toilet i.v. antibioticsi.v. antibiotics Hyperbaric oxygenHyperbaric oxygen
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Otitis Externa – when to Otitis Externa – when to referrefer
Refer if: Non responsive
Canal oedematous
Needs aural toilet
Suspicion of malignant OE
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KaposiKaposi SarcomaSarcoma
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Kaposi sarcomaKaposi sarcoma
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Acute Otitis MediaAcute Otitis Media
Rx : Systemic antibiotics
Analgesia
Decongestants
Symptoms:
Pain DischargeHearing loss Pain subsides
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Acute Otitis MediaAcute Otitis Media
When to refer?:
• Failure of resolution
• Persistent discharge
• Complications• VII palsy• Mastoiditis
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Acute MastoiditisAcute Mastoiditis
Rx : Systemic antibiotics
Analgesia
URGENT REFERRAL
Features
Recent URTIEar dischargeBlunting of postaural sulcusFluctuant tender swellingFever
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Bead in earBead in ear
Rx : one attempt at removal only.
Try syringing with warm water
Do not use forceps for round objects
Non urgent ENT referral
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Insect in EarInsect in Ear
Rx : Kill insect with olive oil
Then try syringing with warm water
Urgent ENT referral
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Bloody OtorrhoeaBloody Otorrhoea
CausesCauses Otitis externa/mediaOtitis externa/media Trauma (local)Trauma (local) Trauma (head injury)Trauma (head injury) PostoperativePostoperative
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Skull Base FractureSkull Base Fracture
Rx : Do not examine ears with an auriscope.
Admit under the head injury team
Non urgent ENT referral
Unless VII Palsy – ENT EMERGENCY
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Case: Facial PalsyCase: Facial Palsy
65yr old female65yr old female 3/52 history right facial 3/52 history right facial
weaknessweakness What are the key points What are the key points
that must be established that must be established in your clinical approach?in your clinical approach?
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Case: Facial PalsyCase: Facial Palsy
Key pointsKey points Establish whether Establish whether
UMNUMN or or LMNLMN
Try and find a Try and find a causecause
Forehead sparing = UMN
Thorough examination
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Facial nerve palsy - causesFacial nerve palsy - causes
UMN (forehead sparing): CVA, MS, CaUMN (forehead sparing): CVA, MS, Ca LMN (complete):LMN (complete):
IntracranialAcoustic neuromaG-BarreTBNeurosarcoidGlomus tumourLyme disease
IntratemporalTraumaAcute otitis mediaMalignant otitis externaRamsey-Hunt syndromeSCCCholesteatoma
ExtracranialTraumaMalignant parotid tumour
Idiopathic = Bell’s Palsy
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Facial Nerve Palsy (Bell’s)Facial Nerve Palsy (Bell’s)
Rx : Prednisolone 30mg
Acyclovir 200mg 5x/day
Hypermellose eye drops
Lacrilube ointment
Red bulging ear drum = URGENT ENT review
If not, Non urgent ENT review
If poor eye closure = Ophthalmology review
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THE NOSETHE NOSE
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Nasal FractureNasal Fracture
Rx : Exclude other max-fax fractures
Exclude CSF rhinorrhoea
Analgesia
Refer if: Obvious deformity (5-7 days)
Septal Haematoma
(URGENT)
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Septal HaematomaSeptal Haematoma
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Normal Inferior TurbinateNormal Inferior Turbinate
SeptumIT
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EpistaxisEpistaxis
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Little’s AreaLittle’s Area
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EpistaxisEpistaxis Children: Recurrent self limiting bleedsChildren: Recurrent self limiting bleeds
Risk factors – URTIs, digital traumaRisk factors – URTIs, digital trauma Adults:Adults:
TraumaticTraumatic Anterior bleedAnterior bleed
Little’s areaLittle’s area Recurrent, self-limitingRecurrent, self-limiting
Posterior bleedPosterior bleed ElderlyElderly Medical comorbidities (hypertension, aspirin, Medical comorbidities (hypertension, aspirin,
warfarin)warfarin) More severeMore severe AdmissionAdmission
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EpistaxisEpistaxis
Rx : RESUSCITATE
FBC, G&S, Clotting
Local pressure
(Cautery)
Nasal Packing
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Nasal PackingNasal Packing
BIPP
MerocelTM
Rapid RhinoTM
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How NOT to pack a nose!!!How NOT to pack a nose!!!
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Foreign Body in NoseForeign Body in Nose
Rx : one attempt at removal only.
Do not use forceps for round objects
Urgent ENT referral
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Orbital cellulitis – Chandler’s Orbital cellulitis – Chandler’s classificationclassification
Grade 1 Periorbital cellulitis (preseptal)
Grade 2 Orbital cellulitis (postseptal)
Grade 3 Subperiosteal abscess
Grade 4 Intraorbital abscess
Grade 5 Cavernous sinus thrombosis
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Subperiosteal abscess – Subperiosteal abscess – Chandler’s grade 3Chandler’s grade 3
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Orbital CellulitisOrbital Cellulitis
Rx : Systemic antibiotics
Decongestants
Analgesia
URGENT ENT referral
URGENT EYE referral
URGENT CT sinuses
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THE THROATTHE THROAT
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Normal tonsilsNormal tonsils
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Acute tonsillitisAcute tonsillitis
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TonsillitisTonsillitis
Rx : Penicillin V/ Metronidazole
Analgesia
FBC, Paul Bunnel, LFT
Refer if: Complete dysphagia
Quinsy
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QuinsyQuinsy
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Foreign body - throatForeign body - throat
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Fish Bone in TonsilFish Bone in Tonsil
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Fish Bones & XrayFish Bones & Xray
Very Opaque:
Cod, Haddock, Cole fish, Lemon sole, Gurnard
Moderate Opaque:
Grey Mullet, Plaice, Monkfish, Red Snapper
Not Opaque:
Herring (Kipper), Salmon, Mackerel, Trout, Pike
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EpiglottitisEpiglottitis
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EpiglottitisEpiglottitis
Children – life threateningChildren – life threatening Adults – supraglottitisAdults – supraglottitis SymptomsSymptoms
FeverFever Recent URTIRecent URTI Sitting forwards, droolingSitting forwards, drooling Sore throatSore throat Plummy voicePlummy voice DysphagiaDysphagia
Causative organism:Causative organism: Children: H Influenzae type BChildren: H Influenzae type B Adults: Broad range of Adults: Broad range of
respiratory pathogensrespiratory pathogens
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Epiglottitis v CroupEpiglottitis v Croup
Epiglottitis Croup
Cause Bacterial ViralAge Any 1-5yrsObstruction Supraglottic SubglotticFever High Low gradeDysphagia Marked NoneDrooling Present MinimalPosture Sitting RecumbentToxaemia Mild to severe MildCough None Barking, brassyVoice Muffled HoarseRR Rapid RapidLaryngeal palpation Tender Not tenderClinical course Rapid resolution Longer resolution
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StridorStridor
Rx : Oxygen
Adrenaline Nebulisers
Heliox
Steroids
Antibiotics
URGENT ENT Ref.
URGENT Anaesthetic Ref.
URGENT Paed. Ref.
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Emergency Trachy??Emergency Trachy??
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CricothyroidotomyCricothyroidotomy
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ENT EmergenciesENT Emergencies
Any Questions?