Facial, Dental, Ear, Nose, and Throat Emergencies
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Transcript of Facial, Dental, Ear, Nose, and Throat Emergencies
*Facial, Dental, Ear, Nose, and Throat Emergencies
*FACIAL EMERGENCIES
*Sinusitis*Bell’s Palsy*Trigeminal Neuralgia
*Facial Lacerations*Soft Tissue Injuries*Mandibular Fractures*Maxillary Fractures*Zygomatic Fractures
* DENTAL AND ENT EMERGENCIES
*Dental*Odontalgia*Tooth Eruption*Pericoronitis*Fractures Tooth*Subluxed/Avulsed Tooth*Dental Abscess*Ludwig’s Angina*Trench Mouth
*Ear*Acute OE*Acute OM*Ruptured Tympanic Membrane*FB*Meniere’s Disease*Labyrinthitis
* DENTAL AND ENT EMERGENCIES
*Nose*Rhinitis*Epistaxis*Nasal Fracture*FB
*Throat*Pharyngitis*Tonsillitis*Laryngitis*Fractured Larynx*Peritonsilar Abscess*FB
*FACIAL
*Assessment
*Nature of Injury/History*Bleeding*Airway Obstruction*Loss of Consciousness*Sensory Deficits/
Changes*Medical /Surgical History*Physical Assessment
*Assessment
*Psychosocial Responses*Stress Factors*Behavioral responses
*Assessment
*Diagnostic Procedures*Radiological*Facial Bones*Water’s View*Skull series*C-spine*CXR*CT
*Assessment
*Diagnostic Procedures*Laboratory*Cultures*Coags*ABGs*T&C
*Priorities
*ABC*Control Bleeding*Fluid and Electrolyte Balance*Prevent Further CNS complications*Control Pain*Relieve Anxiety*Education
*Age-related PearlsPediatric*6-7 year: primary eruption of teeth*Head is larger proportionally than adult’s*Neck muscles are relatively weaker for
large head mass*Always explain and be honest*Limitations in verbal expression*Facial bones are more pliable and softer
*Age-related PearlsGeriatric*Age-related changes*Decreased vital capacity*Diminished ability to cough*Visual acuity changes*Diminished hearing*Loss of short-term memory*Muscle atrophy
*Chronic Disease*Delayed responses*Medications
*Sinusitis
*Inflammation of mucous membranes*Maxillary sinus most common*Frequently follows URI*Other causes: *allergies* dental *infections *trauma*polyps
*Sinusitis
Symptoms*Pain/Pressure*Fever or not*HA*Decreased appetite*Nasal congestion*Nasal voice
*Red, swollen mucosa*Purulent nasal drainage*Conjunctivitis*Tenderness to palpation*Puffy eyes*Bad breath (esp. children)
*Sinusitis
Treatment*Decongestants*Antibiotics*HOB elevated*Apply heat*Room vaporizer*Severe: hospitalization
IV antibiotics Surgery
Education*Should improve 3-4 days*Vaporizer, steam bath*Increase fluids*Avoid smoking*“Rebound congestion”
*Bell’s Palsy
*Paralysis of all facial muscles on one side of face*Usually unilateral*Swelling of facial nerve as a result of virus
or immunodeficiency disease*> 40 yrs*Usually self-limiting*Complete resolution in 80-90% of cases
*Bell’s Palsy
Symptoms*Rapid, acute onset*Hx of Virus?*Unilateral facial
weakness/paralysis*Retro auricular and/or
facial discomfort*Drooling*Dysphagia
*Inability to close eye on affected side*Decreased lacrimation*Drooping of mouth*Speech difficulty*Positive corneal
sensation /negative blink*Inability to wrinkle
forehead
*Bell’s Palsy
*Diagnostics*Exclude other diseases
*Bell’s Palsy
*Treatment/Education*Explain this disease*Not a stroke*Recovery within 3 weeks*Artificial tears*Eye patch*Gentle manual closure of eye*Not contagious
*Keep face warm, avoid drafts*Possible analgesics and
steroids*Moist heat*Facial muscle exercises
*Trigeminal Neuralgia
*Fifth cranial nerve*Usually second and third division –
maxillary and mandibular areas*Brief, recurrent paroxysms of excruciating
facial pain*> 40 yrs and female*Right side affected more often
than left
*Trigeminal Neuralgia
Symptoms*Electrical shock type pain*Unilateral*Minimal to no sensory loss*Painful paroxysms precipitated by touching of trigger zone
Diagnosis*History and physical exam*Exclude other diseases
*Trigeminal Neuralgia
Treatment*Tegretol, Dilantin, analgesics*Surgical interventions
Education*Majority of patients respond
to medical therapy within 48 hrs*25-50% eventually will
require surgical intervention*Avoid cold exposure (iced
drinks, winds, swimming)*Side effects of medications
* Facial lacerations and soft tissue injuries
*Lacerations *Abrasions*Puncture wounds*Contusions*Avulsions*Range from simple isolated injury to those
accompanied by airway obstruction, edema, hemorrhage, facial trauma, and multisystem injuries
* Facial lacerations and soft tissue injuries
Symptoms/Assessment*MOI*Facial asymmetry/swelling*Pain/tenderness*Foreign bodies*Motor and sensory deficits
Diagnosis*Rule other S/S of more extensive facial injures, CNS injury, and multisystem injury*Radiographs*CT*Cultures
*Facial lacerations and soft tissue injuries
*Treatment*Control bleeding*Irrigate wounds copiously*Clean intact skin and wound edges*Replace tissue flaps*Td*Analgesics*Ice to area of trauma, not to avulsed part
*Suture*Anesthetic*Lido with epi unless contrindicated
*Restraint*Lighting*Scissors to cut hair / never shave or cut eyebrows
* Facial lacerations and soft tissue injuries
Education* Wound care
*Mandibular Fractures
*One of the most frequently fractured facial bone*TMJ dislocation may accompany*Fight and crashes most common causes
*Mandibular Fractures
Symptoms/Assessment*MOI*Pain/point tenderness*Malocclusion*Facial asymmetry*Bleeding around mouth*Numbness of lower lip*Trismus*Edema/hematoma
*Ruptured tympanic membrane*Mobility of fracture
fragments*Ecchymosis in floor of
mouth*Sunlingual edema
*Mandibular Fractures
Diagnostics*PA, lateral, oblique skull films*Waters’ *CT
*Mandibular FracturesTreatment*Ensure patent airway*Prevent aspiration of blood, teeth, bone fragments, etc*Control bleeding*Have emergency airway equipment readily available
Ice*Analgesics*Surgical reduction/wiring*Antibiotics*½ and ½ peroxide and
water*Td
*Mandibular Fractures
Education*S/S infection*Mechanical soft diet*Use a straw*Drink plenty of liquids
*Maxillary Fractures
*Less common than mandibular*Usually associated with other multisystem
injuries*LeFort I, II, III*Common causes: fight and crashes
*Maxillary Fractures
Symptoms/Assessment*MOI*Pain/tenderness*Swelling*Asymmetry/distortion*Infraorbital
mobility/paresthesia*Ecchymosis*Epistaxis
*Malocclusion*Visual disturbances*CSF rhinorrhea*Subconjuctival
hemorrhage*Midface maxillary
mobility*S/S of intracranial, spinal,
or multisystem injuries
*Maxillary Fractures
Diagnostics*Waters’ view*Individual facial films*CT scan
*Maxillary Fractures
Treatment/Education*Ensure airway patency*Prevent aspiration*Positioning – Fowler’s/Semi-Fowlers*Emergency intubation available*Control bleeding*Cold packs to face
*Definitive treatment*Open reduction*Internal wiring*Antibiotic prophylaxis*Hospital admission*Td*Support and reassurance
*Zygomatic Fractures
*Causes: Fight, Crash, and Falls*Tripod fractures*Frequently associated with orbital floor
fractures – blow-out fractures
*Zygomatic Fractures
Symptoms/Assessment*MOI*Pain/point tenderness*Bleeding*Edema*Pain with jaw movement*Visual disturbances/diplopia*Facial asymmetry
*Epistaxis*Subjunctival hemorrhage*Paresthesia of cheek, nose, upper lip of affected side*SQ emphysema
*Zygomatic Fractures
Diagnosis*Waters’ view*Submentovertical view
*Zygomatic Fractures
Treatment/Education*Analgesia*Position and elevate head*Ice
*Definitive treatment*Open reduction*Internal wire fixation*Hospital admission*Explanations and reassurance
*DENTAL AND ENT EMERGENCIES
*ASSESSMENT
History*Bleeding*Obstructed Airway*Swelling/Edema*Asymmetry/
Dislocation*Fever/Chills*Nausea/Vomiting*Drooling
*Facial numbness*Dysphasia/Dysphagia*Foul odor and taste in mouth*Loss of hearing*Tinnitis or vertigo*Trismus*Discharge/Drainage
*ASSESSMENT
*Itching*Neck pain*HA
*Medical History*HTN*CAD*Atherosclerosis*Neuro diseases*Dental/ENT surgery and/or infections*CA*Smoking*Diabetes
*DIAGNOSTICS
*Radiology*Chest*Waters’*CT scan
*Laboratory*Cultures*CBC*Sed rate*Coags*ABGs
*PRIORITIES
*ABCs*Control Bleeding*Fluid Volume*Pain control*Anxiety*Definitive Treatment*Prevent Complications*Education
*Age-Related Pearls
*Pediatric*85% of FB aspirations < 3 y/o* Boys twice as likely than girls
*Persistent cough or chronic wheezing may be indicative of aspirated FB
*In 20-38% of esophageal ingestions there are no symptoms*Abrupt onset of respiratory and pulmonary symptoms
suggest FB ingestion.
*Irritability and lack of feeding in infants may be potential S/S of ENT/Dental emergencies
*Age-Related Pearls
*Geriatric*Difficulty in mastication*Loss of sensation*Progressive hearing loss*Most dental and ENT emergencies in the
elderly is related to falls, visual changes, MVCs, and assaults
*Dental
*Odontalgia
*Toothache / Dental caries*Sharp to throbbing*If left untreated, will eventually lead to
necrosis*Prevention is best treatment
*OdontalgiaSymptoms*Pain in diseased tooth*May be referred to gum line, jaw, temple, ear, neck*More intense nocturnal pain*Heat or cold stimulus*Tooth discoloration*Foul breath
Diagnostics*Rule out abscess
*Odontalgia
Treatment*Topical anesthetic*Antibiotics*Analgesic
Education*Preventative hygiene*Follow-up with dentist
*Tooth Eruption
*Primary teeth in infants and children*Wisdom teeth
*Tooth Eruption
Symptoms*Pressure/Tenderness*Irritability/Agitation*Low-grade temp*Diarrhea*Refusal to eat or drink
*Nasal discharge*Crying*Drooling*Reddened, edematous tissue over erupting tooth*Rash around mouth
*Tooth EruptionTreatment*Gentle massage*Teething ring*Orajel*Tylenol/Ibuprofen*Warm saline mouth rinses*Soft solid diet
*Pericoronitis
*Erupting or impacted molars*Acute inflammation surrounds the gingival
tissue or crown of erupting tooth*Commonly seen in the 30 y/o adult*Complications: cellulitis, Ludwig’s angina,
and peritonsillar abscess
*PericoronitisSymptoms*Nonspecific diffuse extraoral pain or pain upon opening mouth*Earache on affected side*Sore throat, jaw pain*Unerupted third molar*Red, inflamed soft tissues around crown
*Lymphadenopathy, trismus and fever if has progressed to systemic
*Pericoronitis
Treatment/Education*Irrigate pericoronal flap with warm NS to remove debris*Refer to dentist for debridement or tooth extraction
*If infection:*Antipyretics*Antibiotic*Assist with drainage of abscess
*Fractured Tooth
*Common causes: Falls, MVCs, Physical abuse, Sport-related injuries, Seizures*Ellis Class I – *involve only the enamel, minor, rough appearance
*Ellis Class II *Enamel portion and the dentin*Pain sensitivities*Should be seen by dentist in 24hr
*Fractured Tooth
*Ellis Class III –*Enamel portion, dentin, and pulp*Dental Emergency
*Fractured ToothSymptoms/Assessment*MOI*Disfigurement of tooth/change in color*Pain/tenderness*Spontaneous*Hot or cold*Inspiration
*HA*N/V Involvement of enamel, dentin, pulp*Malocclusion*Bleeding*Intraoral or extraoral wounds
*Fractured Tooth
Treatment*Suspect and rule out other injuries*Fracture involving enamel and dentin*Apply Calcium Hydroxide to protect*Mild oral analgesic*Dental referral within 24 hrs*Antibiotics
*Fracture involving pulp*High risk of infection*Apply Calcium Hydroxide
to exposed crown surface*Oral analgesic*Dental referral for
pulpectomy
*Subluxed/Avulsed Tooth
Symptoms/Assessment*Pain at site *Bleeding*Neck pain*Respiratory status*Other wounds*Other injuries*Prevalent in ages 7-10
Treatment*Local anesthetic*Subluxed or partially avulsed
should be repositioned for stability*Avulsed must be replanted with
30 minutes (no longer than 6 hrs)*Clean mouth and socket with NS
or cold water*Tooth should be transported in
moist saline gauze or milk
*Subluxed/Avulsed Tooth
Education*Minimal mobility will
usually heal within 2 weeks*Soft diet*Avoid biting into anything
with affected tooth*Avoid hot and cold
substances*Refer to dentist or oral
surgeon
*Dental Abscess
*Localized accumulation of pus in a cavity of a tooth*Gingival swelling results from plaque and debris collecting
between tooth and gingiva*Peridontal disease results when infections spreads into
surrounding tissues and bone*Periapical abscess results when infections has spread
beyond the bone and the virus, bacteria has colonized
*Dental Abscess
Symptoms*Pain*May radiate to ear, jaw, and neck*Not relieved by analgesics*Swelling of face, neck, pharynx*Fever
*Bad breath*Malaise*Chills*Sore gums
Treatment*Systemic analgesic*Antipyretic*Assist with I&D (may leave drain in place)*Educate warm NS rinses every 1-2 hrs*Refer to dentist
*Dental Abscess
Diagnosis*Soft tissue X-ray*WBC*Culture
*Ludwig’s Angina
*Results from a secondary dental infection involving the lower second and third molars*Bilateral diffuse swelling and extending cellulitis
involving the submandibular, submental, and sublingual areas occurs*Difficulty talking and swallowing and breathing ensues
as the neck and face become swollen and causes elevation of the tongue
*Dyspnea*Pallor or cyanosis*Tachycardia*Agitation
*Ludwig’s AnginaSymptoms*Pain and swelling of jaw and neck*Fever/Chills*Malaise*Dysphagia*Dysphasia*Elevation of tongue and floor of mouth toward palate
*Ludwig’s Angina
Diagnosis*CBC*Sed rate*Soft tissue films*Cultures of exudate
*Ludwig’s Angina
Treatment*Maintain airway(emergency cric)*Fowler’s position*Oxygen*I&D (with culture)*Antibiotic
Education*Rinse mouth with warm NS 2-3 times every hour*Hot, moist compress to jaw and neck every hour
*Alveolitis
*a.k.a Dry Socket*Pain post extraction more than 2-3 days*Best treated with irrigation of the clot and
topical oral analgesia/anesthetic*Monitor for development of osteomyelitis
*Post-extraction Bleeding
*Small vessels that continue to bleed*Have patient bite on gauze over
extraction site for 30 minutes*May be anesthetized with lido with epi
and sutured*Avoid hard or hot foods
*Acute Necrotizing Ulcerative Gingivitis
*Trench Mouth*Non-contagious*May follow a URI*Also associated with debilitating illnesses, emotional
stressors, nutritional deficiencies, and smoking
*Acute Necrotizing Ulcerative Gingivitis
Symptoms/Assessment*Pain*Fever/Chills/Malaise*Bleeding gums*Poor oral hygiene*Fetid breath*Lymphadenopathy*Gray ulcers on pharyngeal structures
Treatment*Topical or local anesthetic*Antibiotics*Antipyretic*Refer to dentist*Teach proper oral hygiene
*EAR
*Acute Otitis Externa
*Swimmer’s Ear*Inflammation of external auditory canal
and auricle of the ear
*Acute Otitis Externa
Symptoms*Pain/Tenderness*Diminished hearing*Swelling/Redness/ Discharge*Pruritis*Low-grade fever*Fullness in ear*Cellulitis
*Acute Otitis Externa
Treatment*Topical antibiotic for one week*Cleaning debris out of ear with cotton tip applicator, suction
*Ear wick saturated with antibiotic and/or steroids when ear canal is acutely swollen*Hot, moist compress*Keep ear canal dry
*Acute Otitis Media
*Bacterial infection of middle ear*Causes: barotrauma, Eustachian tube
dysfunction, and URI*Swelling prevents effective drainage and
allows bacteria to proliferate*Commonly seen in infants and children
*Acute Otitis Media
Symptoms/Assessment*Earache that increases with prone position*Pulling at the ear*Sensation of fullness in ear*Decreased hearing*URI*Fever/Chills
*Anorexia*Vertigo/dizziness*Purulent nasal drainage*Erythema of pharynx*Erythema of TM*Retracted or bulging TM
*Acute Otitis Media
Treatment/Education*Antibiotic*Antipyretic*Analgesic*Follow-up within 2 weeks
*Ruptured Tympanic
Membrane
*Primarily caused by infection*May be caused from impact injury and
explosive acoustic trauma*Healing is usually spontaneous
*Ruptured Tympanic Membrane
Symptoms/Assessment*Pain*Bloody or purulent discharge*Vertigo*Tinnitus*Fever/Chills*Barotrauma
*Previous infection/illness*Slit-shaped or irregular TM*Decreased hearing in ear*Disequilibrium
*Ruptured Tympanic
Membrane
Treatment/Education*Antibiotic*Analgesic*Antipyretic*May need to assist in removing blood and debris from ear canal
*Avoid getting ear wet*Hydration*Follow-up
*Foreign Body In Ear*Commonly seen in adults*Avoid irrigating vegetable FBs*Mineral oil or 2% Lidocaine for insects
*Foreign Body In Ear
Symptoms/Assessment*Discomfort or pain*Decreased hearing*Swelling of external ear*Insect buzzing in ear*Agitation
*Foreign Body in Ear
Treatment/Education*Assist with removal*Irrigation*NS*Alcohol*Mineral oil*Lidocaine
*Suction*Use Flashlight for insect
*Meniere’s Disease
*Disorder of the vestibular system in the inner ear*Abnormal accumulation of fluid in the cochlea and
labyrinth causing severe rotary vertigo, N/V, and tinnitus*Commonly seen 40-60 y/o*Causes: blow to the head, infection, allergies, or
degeneration of the inner ear*Attack may last several hours
*Meniere’s Disease
Symptoms/Assessment*Rotational vertigo*Falls toward affected ear*N/V*Diaphoresis*Tinnitus*Hearing loss*Heightened sensitivity to sounds
*HA*Blurred vision*Moist, pale skin*Nystagmus*Rule out intracranial lesion*Hx of otitis media
Education* Safety R/T
vertigo, falling, meds
* Make position changes slowly
* Follow-up* Avoid alcohol and
caffeine * Hydration
*Meniere’s DiseaseTreatment
*Medications*Diuretics*Anti-emetic*Antihistamines*Vasodilator
*Bed Rest*Quiet environment*Surgery if severe and refractory to medical tx
*Labyrinthitis
*Inflammatory response of the inner ear; may involve nerves connecting the inner ear to the brain*Bacterial or Viral
*HA*Disequilibrium*Normal neuro exams*Orthostasis*Recent hx of ear infection, URI, viral illness
*Labyrinthitis
Symptoms/Assessment*Patient feels they are moving*Unsteadiness*N/V*Hearing abnormalities*Ear pressure
*Labyrinthitis
Treatment*Antihistamines*Antiemetics*Sedatives*IVF*Antibiotics
*NOSE
*Rhinitis
*Inflammatory condition of the nasal mucosa*Viral or bacterial URI*Spread by droplet contact
*Rhinitis
Symptoms/Assessment*Sneezing*Postnasal drip/Copious
nasal discharge*Nasal obstruction*Muscle aches*Malaise*HA*Water or itchy eyes
*Sore throat*Mild fever/chills*Inflammation of throat and
sinuses*Nasal mucosa
erythematous, edematous, and congested
*Rhinitis
Treatment/Education*Antipyretics*Decongestants*Antihistamines*Nasal corticosteroid*Hydration
*Teach to use nasal decongestants for only a few days*Symptoms usual resolve in
7 days
*Epistaxis
*Usually results from the erosion of superficial blood vessels from the anterior and inferior nasal septum*Causes: Nose-picking, FB, Nasal trauma,
Rhinitis, Forceful nose blowing*Anterior epistaxis usually treated with frim
pressure (pinching)*Posterior epistaxis requires nasal packing
*Epistaxis
Symptoms/Assessments*Bleeding*History of epistaxis*Recent trauma or surgery*N/V*Hx of aspirin and/or antiplatelets meds*Hx of HTN/atherosclerosis
*Erythema and swelling of nasal mucosa*Blood in auditory canal*Anxiety*Tachycardia*Sense of impending doom
*Epistaxis
Treatment/Education*ABCs*Control bleeding*Direct pressure*Nasal packing*Suctioning*Cauterization*Hemostatic material*Establish IV
*Medications*Anesthetic*Topical vasoconstrictors*Decongestant*Antihypertensives*Avoid blowing nose forcibly
*Nasal Fracture
*Most frequently fractured bone
*Nasal Fracture
Symptoms/Assessment*MOI*Visual deformity*Swelling*Nasal bleeding*Nasal obstruction*Crepitus*Pain/Tenderness*Rule out septum injury
Diagnosis*Nasal/facial films
*Nasal Fracture
Treatment/Education*Assess for other injuries*Control hemorrhage*Direct pressure*IV*Packing*Ice pack
*Medications*Anesthetic*Decongestant*Vasoconstrictor*Analgesic*Antibiotics
*Foreign Body In Nose*Commonly seen in children
*Foreign Body In Nose
Symptoms/Assessment*Nose pain/swelling*Nasal discharge*Foul smell from nose*Unilateral bleeding*Agitation
Treatment/Education*Blow nose to dislodge or remove*Topical vasoconstrictive*Assist in removal*Suction*Forceps*Foley catheter
*Throat
*Pharyngitis
*Sore Throat*Usually associated with viral URI*Most cases resolve with symptom
management*Spread by droplet transmission*Common during late fall, winter, early
spring*Strep
*Pharyngitis
Symptoms/Assessment*Sore throat*Difficulty swallowing*Pain referred to ears, neck, jaw*Fever/Chills*Harsh cough*Anorexia*Fatigue*Body aches
*Enlarged tonsils*Cervical lymphadenopathy*Exudate on pharynx and/or tonsils*Foul breath*Nasal speech*Flushed face
*Pharyngitis
Treatment/Education*Antipyretic*Analgesic*Steroids*Antibiotics*Warm saline irrigation*Rest*Hydration*Follow-up
*Tonsilitis
*Tonsils act as filters for lymphatic circulation*Similar to pharyngitis
*Tonsilitis
Symptoms/Assessment*Throat Pain*Recent URI*Pain/Difficulty swallowing*Referred pain*Fever/Chills*Fatigue*Fetid breath
*Tachycardia*Red and swollen tonsils*Purulent exudate on tonsils*Enlarged cervical and
submandibular lymph nodes*Flushed face*Culture (strep)
*Tonsilitis
Treatment/Education*ABC*Warm saline irrigation*Hydration (cool liquids)*Rest*Antibiotic*Antitussive*Steroids*Follow-up
*For chronic tonsilitis: tonsillectomy
*Laryngitis
*Hoarseness*Voice harsh and raspy*Commonly a viral infection*Constant urge to clear the throat or
tickling sensation
*Laryngitis
Symptoms/Assessment*Dry, tickling sensation in
throat*Partial to complete loss of
voice*Hoarseness*Fever/Chills*Sore throat*Dyspnea
*Difficulty swallowing*Dry cough*Anorexia*Reddened larynx and vocal
cords*Swelling of larynx and
epiglottis*Rhinorrhea*Throat cultures
*Laryngitis
Treatment/Education*Warm room that
humidified*Rest voice*Antibiotic*Inhaled steroid*Antitussive
*Antipyretic*Zinc*Ice to anterior throat*Humidifier
*Fractured Larynx
*Results from direct trauma (blunt or penetrating) to neck
*Common causes: MVC, strangulation, sports injuries
*Fractured Larynx
Symptoms/Assessment*MOI*Hoarseness*Change in voice*Pain on swallowing*Cough*Dyspnea*Hemoptysis
*Ecchymosis*Abrasions*SQ emphysema*Loss of normal prominence
of thyroid cartilage*Inspiratory stridor*Substernal or Intercostal
retractions
*Fractured Larynx
Diagnosis*CT scan*Rule out other injuries*Soft tissue films are not sensitive to laryngeal injury
Treatment*ABC / C-spine*Cric or trach*High humidity oxygen*ABGs*Treat concomitant injuries*Surgery
*Peritonsillar abscess
*Infection penetrating the tonsillar capsule and superior constrictor muscle into the surrounding areolar tissue*Streptococci bacteria are usually the
pathogen*Drainage of pus by an ENT
or oral surgeon provides immediate relief
*Peritonsilar abscess
Symptoms/Assessment*Sore throat*Pain on swallowing*Ear fullness*Fever/Chills*Pus / exudate on tonsils*Difficulty opening mouth*Drooling*Muffled voice
*Difficulty breathing*Enlarged affected tonsil*Displacement of uvula*Edema and erythema of
soft palate*Profuse salivation*Torticollis*Increases respiratory rate*Recent tonsilitis
*Peritonsillar abscess
Diagnosis*Culture and sensitivity
*Peritonsillar abscess
Treatment*ABC*Pulse OX*Oxygen*HOB 60 to 90°*IV hydration and medication
*Warm saline irrigation*Antibiotics Topical anesthetic*Analgesic*Antipyretic*Ice collar to throat*I&D
*Foreign Body In Throat
*Common cause of accidental death in US Children < 6 y/o*Can lead to obstruction of mainstem
bronchus or distal trachea*Airway management is priority*Heimlich maneuver and/or
abdominal thrusts
*Foreign Body In Throat
Symptoms/Assessment*Sore throat*Vocal changes*Drooling*Coughing*Difficulty swallowing
and/or breathing*Difficulty talking*Known ingestion
*FB visible in pharynx or larynx*Stridor*Tachycardia*Excessive salivation*Skin cool and moist*Hemoptysis*Hematemesis*Agitation
*Foreign Body In Throat
Diagnosis*PA and lateral CXR*Soft tissue of neck
*Foreign Body In Throat
Treatment/Education*ABC*Finger sweep*Heimlich*Oxygen*IV*HOB 60 to 90°
*Prepare for potential emergency intubation*Minimize environmental stimuli*Removal procedures*Balloon-tipped Foley*IVCS