Dr. Maha Al-Sedik. Objectives: Anatomy, physiology of the ear. Patient Assessment. ...
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Transcript of Dr. Maha Al-Sedik. Objectives: Anatomy, physiology of the ear. Patient Assessment. ...
Diseases of the Eyes, Ears, Nose, and Throat- 3
Dr. Maha Al-Sedik
THE EAR
Objectives:
Anatomy, physiology of the ear.
Patient Assessment.
Pathophysiology of the ears.
Divided into three anatomic parts:
Outer ear
Middle ear
Inner ear
Anatomy and Physiology of the Ear
Anatomy and Physiology of the Ear
The ear is the primary structure for hearing and
balance.
Disorders and injuries can leave a person unable to:
Hear.
Communicate.
Maintain equilibrium.
1. Sound waves enter the ear.
2. Travel to the tympanic membrane.
3. Sound waves set up vibration in the ossicles ( stapes
– incus – malus ).
4. Vibrations transmit to the inner ear.
5. At organ of Corti, vibrations form impulses.
6. Travel to the brain via the auditory nerve.
How do we hear?
Patient assessment steps
Scene size-up
Primary assessment
History taking
Secondary assessment
Reassessment
Scene Size-up: A- Scene safety
Use standard precautions e.g. gloves
and eye protection.
Use PPE (personal protective equipment) .
Consider possibility of toxic substance through
determination of the number of patients; toxic
environments may produce multiple patients.
Consider potential for violence.
B- Mechanism of injury ( MOI )/nature of illness (NOI):
Nature of illness is often based on history of
chronic medical problems.
Ensure that the eye emergency is not the result
of a traumatic event.
Usually the NOI can be determined by the
patient’s chief complaint or by asking family
members or bystanders.
Primary Assessment
I• Form a General Impression
II• Airway and Breathing
III• Circulation
IV• Transport Decision
Form a General Impression:
Note the position of the patient, and identify any
immediate life threats.
Determine priority of care based on the MOI/NOI.
A rapid scan of the patient will help you identify and
manage life threats.
Assess the patient’s level of consciousness using the
AVPU scale.
Obtain the chief complaint from the patient if
possible.
Alert to person, place, and day
responsive to Verbal stimuli
responsive to Pain
Unresponsive
Airway and Breathing:
Ensure the airway is open, clear, and self-maintained.
A patient with an altered level of consciousness may
need emergency airway management.
when a cervical spine injury is suspected, open and
maintain the airway using a modified jaw-thrust .
if nontraumatic situations, a head tilt–chin lift
maneuver.
Consider inserting a properly sized oropharyngeal
or nasopharyngeal airway.
Suction as needed.
Evaluate the patient’s ventilatory status for rate
and depth of breathing, respiratory effort.
Quickly assess the chest for accessory muscle use,
and intercostal and abdominal muscle use.
Assess lung sounds, and determine whether they are
normal, decreased, abnormal, or absent.
Administer high flow oxygen at 15 L/min, providing
ventilatory support as needed.
modified jaw-thrust
Place the patient on his or her back.
Place one hand on the patient’s forehead and
apply firm pressure backward.
Place the tips of your fingers under the bony part
of the lower jaw.
Lift the chin forward and tilt the head back.
Head tilt–chin lift maneuver
Oropharyngeal devices
Nasopharyngeal airway
How to select the suitable size?
Suction:
The purpose of suction is to remove vomit, blood,
excretions, and other matter from the airway.
Here are some guidelines to use for suctioning:
Measure the tip from corner of mouth to earlobe
Oxygenate the patient well (if the situation
permits)
Insert the tip into the oral cavity without applying
suction
Move the suction tip side–to-side
Oxygenate well after suctioning
Suction
Circulation: Evaluate distal pulse rate, quality (strength), and
rhythm.
If distal pulses are not palpable, assess for a
central pulse.
Establish vascular access.
Consider drawing blood samples.
Observe skin color, temperature, and condition.
Cyanosis
Transport decision:
If the patient has an airway or breathing problem,
signs and symptoms of internal bleeding, or other life
threats, manage him or her immediately and consider
rapid transport to the nearest hospital performing the
secondary assessment en route to the hospital.
History Taking
Investigate chief complaint ( sample – OPQRST):
Signs and symptoms
Allergies (med allergies)
Medications
Past medical history
Last meal or intake
Events leading to call
SAMPLE
O – Onset
When did it begin?
P – Provocation
What were you doing when it began?
Q – Quality
Can you describe the feeling you have?
R – Radiation
Does the feeling spread to any other parts of your body?
OPQRST
S – Severity
On a scale of 1-10, how bad is the trouble breathing?
(1 is best, 10 worst).
T – Time
How long have you had this feeling?
Secondary Assessment
I
• Physical Examinations
II
• Vital Signs
Physical Examinations
Observe ears for:
Drainage
Excess cerumen
Inflammation
Swelling
Presence of hearing aid(s)
Have patient rate his or her pain.
Ask about:
Changes in hearing.
Dizziness. Inspect for:
Wounds.
Swelling.
Drainage.
Mastoid process.
Vital signs
Document:
Pulse rate, rhythm, and quality
Respiratory rate, rhythm, and quality
Blood pressure
Temperature.
Pathophysiology of the ears
Foreign Body
Usually seen in pediatric patients
Assessment and management
• Determine the nature of the object.
• Look for bleeding, redness, or inflammation.
• Stabilize impaled objects in place.
• Transport in a position of comfort.
Impacted Cerumen
Yellowish oily substance found in outer ear.
May present as:
“Wet”: a sticky brown color.
“Dry”: a grayish flaky substance.
Can become impacted.
Risk factors include:
Abnormal ear canal shape.
Diseases that cause increased cerumen.
Improper use of cotton swabs .
Assessment and management:
• Symptoms may include:
Pressure or fullness in the ears.
Ringing in the ears.
Loss of hearing.
Prehospital treatment includes:
Thorough history
Visual inspection of the ear
Labyrinthitis
Feeling of vertigo or loss of balance after an ear
infection or upper respiratory infection.
Other symptoms may include:
o Ringing in the ears.
o Loss of hearing.
o Vomiting.
Assessment and management:
Prehospital treatment is directed at:
• Reducing nausea and vomiting.
• Transporting the patient in a position of comfort
Serious disorders will need to be ruled out by a CT
scan and an MRI.
Otitis Externa and Media
Infection resulting from bacterial growth in the ear canal
Externa: outer ear
Media: middle ear
More common in children than adults
Assessment and management
Signs and symptoms may include:
Edema and erythema
Diminished hearing acuity
Inflamed, bulging tympanic membrane
Pre hospital treatment: relieving unbearable
symptoms
Perforated Tympanic Membrane
Ruptured eardrum
Results from:
Foreign bodies in the ear
Pressure related injuries
Diving-related injuries
Assessment and management
Signs and symptoms include:
Loss of hearing.
Blood drainage from the ear.
Pain.
Assess and treat other injuries.
Transport for evaluation.
THANK YOU