Common ENT Challenges - Cleveland Clinic · Confidential11 DOS CME Course 2011DOS Course...
Transcript of Common ENT Challenges - Cleveland Clinic · Confidential11 DOS CME Course 2011DOS Course...
DOS Course 2015 1 DOS CME Course 2011 1 October 2010 1 Confidential
Common ENT Challenges
Cerumen Removal Nasal Cautery for Epistaxis
Foreign Body – Ears and Nose Peritonsillar Abscess
Tom I. Abelson M.D.
Medical Director Cleveland Clinic Beachwood Family Health and Surgery Center Department of Otolaryngology Head and Neck Institute Cleveland Clinic
© Cleveland Clinic 2014
Cerumen Removal
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Roland P S et al. Otolaryngology -- Head and Neck Surgery 2008;139:S1-S21
Ear Candling
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Cerumen Removal
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Cerumen Removal
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Cerumen wire loop
Small blunt hook
Cerumen (or Foreign Body) Removal
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Cerumen Removal
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Cerumen Removal
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Cerumen Removal
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Cerumen Removal
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Cerumen Removal
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Cerumen Removal
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Nasal Cautery
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• Remove blood and clots from nose
• Place topical medication using cotton pledget – 50-50 mixture of:
–4% topical lidocaine or other topical anesthetic –Oxymetazoline or Phenylephrine
• Repeat
• Cauterize with silver nitrate – Apply – Dry – Repeat until epistaxis controlled
• May pack with merocel, perhaps covered with resorbable packing material (fibrillar or gelfoam) – leave 4-5 days
Nasal Cautery
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• Nasal speculum • Cotton pledget • Bayonet forceps • Silver nitrate • Applicator
Nasal Cautery
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Posterior epistaxis
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Nasal Packing
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• Nasal packing can be Vaseline gauze, merocel sponge, dissolvable material such as fibrillar or gelfoam
• Leave packing for 4-5 days
• Put patient on broad spectrum antibiotic such as cephalexin to prevent bacterial overgrowth and toxic shock
• Expect a small amount of oozing of blood for a brief period of time after removal of packing because of mucosal irritation.
Peritonsillar Abscess
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• Symptom – Unilateral throat pain – Trismus – “Hot potato” voice
• Physical Exam – Unilateral swelling of the peritonsillar tissues, extending into the
soft palate – Deviation of the uvula to the opposite side – Effacing of the junction between the tonsil and the soft palate and
anterior tonsil pillar – Cervical adenopathy or soft tissue swelling and tenderness
• Lab – Increase WBC with left shift
Peritonsillar Abscess
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Peritonsillar Abscess
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Peritonsillar Abscess
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Dental Trauma in Primary Care
Thanks to:
Tod Coy DDS Cleveland Clinic
Edward Ginsberg DDS
Assistant Clinical Professor University of Maryland School of Dentistry
Johns Hopkins Hospital
• Check for other facial fractures or head and neck trauma
• 70% of all dental injuries involve maxillary central incisors
• Check for dental fractures, mobility, tooth malposition
• Question regarding sensitivity to hot/cold
• Prefer panorex or intraoral dental radiography over CT
Clinical Evaluation
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Dental Anatomy and Numbering
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• Fracture
• Avulsion
• Luxation
Injury Classification
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Dental Injury Classification
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• Ellis Class I – Enamel only – No emergency care. Follow-up with dentist.
• Ellis Class II – Enamel / dentin with sensitivity – Cover exposed dentin with dental cement (dycal) and referral to
dentist within 24 hours.
• Ellis Class III – Enamel / dentin / pulp – Cover with dental cement (dycal) and immediate dental referral.
Fracture
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Dental Anatomy
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• Adult teeth should be reimplanted as soon as possible and handled only by the crown portion of the tooth.
• If reimplantation is not possible then place in a protective medium (Hank’s Balanced Salt Solution, saline, milk).
• In children with avulsions primary teeth are never reimplanted.
Avulsion
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• Concussion – Mild injury to periodontal ligament, no mobility. – Soft diet, NSAIDs, dental referral
• Subluxation – Tenderness to palpation, slight mobility of tooth. – Soft diet, NSAIDs, dental referral
• Extrusion – Reposition tooth to original position and splint in place.
Luxation
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• Lateral luxation – Reposition tooth and splinting. – Should be done by dentist or oral surgeon if significant alveolar
fracture is present.
• Intrusion – Typically no emergency care by general practitioner. – Referral to dentist within 24 hours.
Luxation
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References
Harrison L. Dental trauma: guidelines for pediatricians updated. Medscape Medical News. January 27, 2014. Available at http://www.medscape.com/viewarticle/819755. Accessed February 3, 2014.
Keels MA. Management of dental trauma in a primary care setting. Pediatrics. Feb 2014;133(2):e466-76.
Dentaltraumaguide.com Per Dr. Ginsberg
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