Dr. Maha Al-Sedik. Objectives: Anatomy, physiology of the ear. Patient Assessment. ...

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Diseases of the Eyes, Ears, Nose, and Throat- 3 Dr. Maha Al-Sedik

Transcript of Dr. Maha Al-Sedik. Objectives: Anatomy, physiology of the ear. Patient Assessment. ...

Page 1: Dr. Maha Al-Sedik. Objectives:  Anatomy, physiology of the ear.  Patient Assessment.  Pathophysiology of the ears.

Diseases of the Eyes, Ears, Nose, and Throat- 3

Dr. Maha Al-Sedik

Page 2: Dr. Maha Al-Sedik. Objectives:  Anatomy, physiology of the ear.  Patient Assessment.  Pathophysiology of the ears.

THE EAR

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Objectives:

Anatomy, physiology of the ear.

Patient Assessment.

Pathophysiology of the ears.

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Divided into three anatomic parts:

Outer ear

Middle ear

Inner ear

Anatomy and Physiology of the Ear

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Anatomy and Physiology of the Ear

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The ear is the primary structure for hearing and

balance.

Disorders and injuries can leave a person unable to:

Hear.

Communicate.

Maintain equilibrium.

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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?

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Patient assessment steps

Scene size-up

Primary assessment

History taking

Secondary assessment

Reassessment

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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.

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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.

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Primary Assessment

I• Form a General Impression

II• Airway and Breathing

III• Circulation

IV• Transport Decision

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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.

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Alert to person, place, and day

responsive to Verbal stimuli

responsive to Pain

Unresponsive

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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.

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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.

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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.

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modified jaw-thrust

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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

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Oropharyngeal devices

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Nasopharyngeal airway

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How to select the suitable size?

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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

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Suction

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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.

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Cyanosis

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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.

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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

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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

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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?

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Secondary Assessment

I

• Physical Examinations

II

• Vital Signs

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Physical Examinations

Observe ears for:

Drainage

Excess cerumen

Inflammation

Swelling

Presence of hearing aid(s)

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Have patient rate his or her pain.

Ask about:

Changes in hearing.

Dizziness. Inspect for:

Wounds.

Swelling.

Drainage.

Mastoid process.

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Vital signs

Document:

Pulse rate, rhythm, and quality

Respiratory rate, rhythm, and quality

Blood pressure

Temperature.

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Pathophysiology of the ears

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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.

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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.

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Risk factors include:

Abnormal ear canal shape.

Diseases that cause increased cerumen.

Improper use of cotton swabs .

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Assessment and management:

• Symptoms may include:

Pressure or fullness in the ears.

Ringing in the ears.

Loss of hearing.

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Prehospital treatment includes:

Thorough history

Visual inspection of the ear

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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.

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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.

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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

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Assessment and management

Signs and symptoms may include:

Edema and erythema

Diminished hearing acuity

Inflamed, bulging tympanic membrane

Pre hospital treatment: relieving unbearable

symptoms

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Perforated Tympanic Membrane

Ruptured eardrum

Results from:

Foreign bodies in the ear

Pressure related injuries

Diving-related injuries

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Assessment and management

Signs and symptoms include:

Loss of hearing.

Blood drainage from the ear.

Pain.

Assess and treat other injuries.

Transport for evaluation.

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