Emergency Tht
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Transcript of Emergency Tht
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BLOK EMERGENCY
THT
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Overview
Otologic Disorders
Nasal Disorders
Facial, Oral and Pharyngeal
Infections
Airway Obstruction
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Otologic Disorders
Anatomy
Auricle
Ear canal
Tympanic
membrane Middle ear and
mastoid disorders
Inner Ear
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Aspiration of Auricular Hematoma
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Auricle
Chondritis - Cellulitis ?- infectious, difficult to treat
because poor blood supply,
cover S. Aureus and
pseudomonas
- extra care in diabetics
- inflammatory causes related
to seronegative arthritis at
times indistinguishable from
infection usually the ear lobeis spared
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Otitis Externa
Infection and inflammationcaused by bacteria
(pseudomonas, staph), and
fungi
- treat with antibiotic-steroiddrops
- use wick for tight canals
- diabetics can get malignant
otitis externa (defined by the
presence of granulation
tissue)
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Foreign Bodies in Ear Canal
Usually put in by patient,
some bugs fly in
kill bugs with mineral oil,
or lidocaine remove with forceps,
suction or tissue adhesive
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Tympanic Membrane Perforation
Hard to seeHx of drainage Usually from middle ear pressure
secondary to fluid or barotrauma
Sometimes from external trauma
most heal uneventfully but all needotology follow-up
perfs with vertigo and facial nerveinvolvement need immediate referral
treat with antibiotics
drops controversial but indicated forpurulent discharge (avoid gentamycindrops)
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Middle Ear Serous Otitis Media - Eustachian
tube dysfunction - treat withdecongestants, decompressive
maneuvers
Otitis Media - infection of middle
ear effusion - viral and bacteria
Mastoiditis - Venous connection
with brain, need aggressive
treatment (can lead to brain
abcess or meningitis)
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Inner Ear
peripheral vertigo (vestibulopathy)
BPV, labyrhinthitis
- acute onset, no central signs, usually
young, horizontal nystagmus
Menieres - vertigo, sensorineural hearing
loss, tinnitus
Treatment- valium, fluids, rest, manipulation for BPV
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The Nose
Vascular Supply
- Anterior - branches of
internal carotid
- Posterior - distalbranches of external
carotid
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EpistaxisAnterior
90% (Littles Area) Kisselbachs plexus -usually children, young adults
Etiologies
Trauma, epistaxis digitorum
Winter Syndrome, Allergies
Irritants - cocaine, sprays
Pregnancy
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EpistaxisPosterior
10% of all epistaxis - usually in the elderly
Etiologies
Coagulopathy Atherosclerosis
Neoplasm
Hypertension (debatable)
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Epistaxis
Management
Pain meds, lower BP, calm patient
Prepare ! (gown, mask, suction, speculum,
meds and packing ready)
Evacuate clots
Topical vasoconstrictor and anesthetic
Identify source
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Epistaxis
Management
Anterior Sites- Pressure +/- cautery
and/or tamponade
- all packs require antibiotic
prophylaxis
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Epistaxis
Posterior Packing
Need analgesia and
sedation
require admission and
02 saturationmonitoring
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Epistaxis
Complications
severe bleeding
hypoxia, hypercarbia
sinusitis, otitis media necrosis of the columella or nasal ala
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7th Nerve Palsy
Most cases are idiopathic- link to HSV
- no proof steroids or antivirals are
effective, but many advocate
Consider Lymes Disease inedemic areas
Surgical decompression
indicated in the rare patient not
improving by 2 weeks andENOG out > 90%
F i l I f ti
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Facial Infections
Sinusitis
Signs and symptoms- H/A, facial pain in sinus
distribution
- purulent yellow-greenrhinorrhea
- fever- CT more sensitive than
plain films
Causative Organisms
- gram positives and H. flu(acute)
- anaerobes, gram neg(chronic)
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Facial Infections
Sinusitis Treatmentacute - amoxil, septra
chronic - amoxil-clavulinic acid,clindamycin, quinolones
decongestants, analgesia, heat Complications
ethmoid sinusitis - orbital cellulitsand abcess
frontal sinusitis - may erode bone(Potts Puffy Tumor, BrainAbcess)
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Facial Cellulitis
Most common strept
and staph,
Rarely H.Flu
Can progress rapidly
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Parotiditis
Usually viral-paramyxovirus
Bacterial
- elderly, immunosuppressed
- associated with dehydration
- cover - Staph, anaerobes
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Pharyngitis
Irritants
-reflux, trauma, gases
Viruses
- EBV, adenovirus
Bacterial
-GABHS, mycoplasma, gonorrhea,
diptheria
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Peritonsillar Abcess
Complication of suppurative tonsillitis
Inferior - medial displacement of tonsil and
uvula
dysphagia, ear pain, muffled voice, fever,
trismus
Treatment
- Antibiotics, I&D, +/-steroids
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EpiglottitisClinical Picture
Older children and adults
Onset rapid, patients look
toxic
prefer to sit, muffled voice,dysphagia, drooling,
restlessness
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Epiglottitis
Avoid agitation
Direct visualization if patient allows
soft tissue of neck
- thumb print, valecula sign
Prepare for emergent airway, best achieved
in a controlled setting
Unasyn, +/- steroids
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Epiglottitis
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Retropharyngeal Abcess
Anterior to prevertebral spaceand posterior to pharynx
Usually in children under 4
(lymphoid tissue in space)
pain, dysphagia, dyspnea, fever
swelling of retropharyngeal
space on lateral x-ray
Complications - mediastinitis
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Masticator - Parapharyngeal
Space Infection Infection of the lower
molars invade masticator
space
Swelling, pain fever,
TRISMUS Treatment
IV antibiotics (PCN or
Clindamycin)
ENT admission
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ANUGAcute Necrotizing Ulcerative Gingivitis
Bacterial infection causing anacute necrotizing, destructive
disease of periodontium
Treatment
- oral rinses
- antibiotics (PCN, clindamycin,
tetracycline)
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Ludwigs Angina
Rapidly progressive cellulitis ofthe floor of the mouth
usually in elderly debilitated
patients and precipitated by
dental procedures massive swelling with impending
airway obstruction
Treatment
ICU, antibiotics, airway
management
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Angioedema
Ocassionally lifethreatening
Heriditary and related
to ACE inhibitors
Antihistamines,steroids and doxepin
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Airway Obstruction
Aphonia - complete upper airway
Stridor - incomplete upper airway
Wheezing - incomplete lower airway
Loss of breath sounds- complete lower
airway
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TERIMAKASIH