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    ENT Emergency

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    kyliever
    The document provides guidance on evaluating and treating common ear, nose, and throat (ENT) emergencies, emphasizing the importance of a thorough history and physical exam. It describes conditions like tonsillitis, epiglottitis, nasal fractures, and otitis externa and their presentations, causes, and treatment approaches. Referral criteria are outlined for various ENT issues that require further specialist evaluation.

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    © All Rights Reserved
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    ENT Emergency

    Uploaded by

    kyliever
    115 views57 pages
    The document provides guidance on evaluating and treating common ear, nose, and throat (ENT) emergencies, emphasizing the importance of a thorough history and physical exam. It describes conditions like tonsillitis, epiglottitis, nasal fractures, and otitis externa and their presentations, causes, and treatment approaches. Referral criteria are outlined for various ENT issues that require further specialist evaluation.

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    ENT emergencies

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    The document provides guidance on evaluating and treating common ear, nose, and throat (ENT) emergencies, emphasizing the importance of a thorough history and physical exam. It describes conditions like tonsillitis, epiglottitis, nasal fractures, and otitis externa and their presentations, causes, and treatment approaches. Referral criteria are outlined for various ENT issues that require further specialist evaluation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    115 views57 pages

    ENT Emergency

    Uploaded by

    kyliever
    The document provides guidance on evaluating and treating common ear, nose, and throat (ENT) emergencies, emphasizing the importance of a thorough history and physical exam. It describes conditions like tonsillitis, epiglottitis, nasal fractures, and otitis externa and their presentations, causes, and treatment approaches. Referral criteria are outlined for various ENT issues that require further specialist evaluation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 57
    At a glance
    Powered by AI
    The key takeaways are the importance of history and examination in ENT, and an overview of common ENT conditions such as tonsillitis, epiglottitis, nasal fractures, otitis externa and media.

    The main causes of otitis externa are bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa. Features include discharge, pain, hearing loss and itching. Predisposing factors include water exposure and eczema. Treatment involves topical antibiotics and aural toilet.

    The key features of acute otitis media are pain, discharge and hearing loss that subsides with treatment. Treatment involves systemic antibiotics, analgesia and decongestants. Referral is needed if there is no resolution, persistent discharge or complications such as VII nerve palsy or mastoiditis develop.

    RCSI Royal College of Surgeons in Ireland Coliste Roga na Minle in irinn

    ENT Emergency
    James Paul ONeill
    Professor of Otolaryngology, Head and Neck Surgery
    Importance of History & Exam

    History- presentation of historical findings in the correct


    order with absolute confidence !

    Exam- from inspection to physical exam.

    Become the Doctor you always wanted to be.


    THE THROAT
    Normal tonsils
    Acute Tonsillitis
    Tonsillitis

    Rx : Penicillin V/ Metronidazole
    Analgesia
    FBC, Paul Bunnel, LFT

    Refer if: Complete dysphagia


    Quinsy
    Quinsy

    What is wrong with


    this clinical cartoon ?
    Foreign Body
    Foreign body - throat
    Epiglottis- Swallowing
    Epiglottitis
    Epiglottitis
    Children life threatening
    Adults supraglottitis
    Symptoms
    Fever
    Recent URTI
    Sitting forwards, drooling
    Sore throat
    Plummy voice
    Dysphagia
    Causative organism:
    Children: H Influenzae type B
    Adults: Broad range of respiratory
    pathogens
    Epiglottitis v Croup
    Epiglottitis Croup

    Cause Bacterial Viral


    Age Any 1-5yrs
    Obstruction Supraglottic Subglottic
    Fever High Low grade
    Dysphagia Marked None
    Drooling Present Minimal
    Posture Sitting Recumbent
    Toxaemia Mild to severe Mild
    Cough None Barking, brassy
    Voice Muffled Hoarse
    RR Rapid Rapid
    Laryngeal palpation Tender Not tender
    Clinical course Rapid resolution Longer resolution
    Stridor

    Rx : Oxygen
    Adrenaline Nebulisers
    Heliox
    Steroids
    Antibiotics

    URGENT ENT Ref.


    URGENT Anaesthetic Ref.
    URGENT Paed. Ref.
    Cricothyroidotomy
    THE NOSE
    Nasal Fracture Rx : Exclude other max-fax
    fractures
    Exclude CSF rhinorrhoea
    Analgesia

    Refer if: Obvious deformity


    (5-7 days)
    Septal Haematoma
    (URGENT)
    Nasal Septum
    Septal Haematoma
    Littles Area // Kiesselbachs Plexus

    Anterior ethmoidal artery


    ..from the ophthalmic artery

    Sphenopalatine artery
    ..terminal branch of the maxillary artery

    Greater palatine artery


    ..from the maxillary artery

    Septal branch of the superior labial artery


    ..from the facial artery
    Epistaxis
    Epistaxis

    Children: Recurrent self limiting bleeds


    Risk factors URTIs, digital trauma
    Adults:
    Traumatic
    Anterior bleed
    Littles area
    Recurrent, self-limiting
    Posterior bleed
    Elderly
    Medical comorbidities (hypertension, aspirin, warfarin)
    More severe
    Admission
    Epistaxis

    Rx : RESUSCITATE
    FBC, G&S, Clotting
    Local pressure
    (Cautery)
    Nasal Packing
    Nasal Packing

    BIPP
    MerocelTM
    Rapid RhinoTM
    How NOT to pack a nose!!!
    Foreign Body in Nose

    Rx : one attempt at removal


    only.
    Do not use forceps for round
    objects
    Urgent ENT referral
    Orbital cellulitis Chandlers classification

    Grade 1 Periorbital cellulitis (preseptal)

    Grade 2 Orbital cellulitis (postseptal)

    Grade 3 Subperiosteal abscess

    Grade 4 Intraorbital abscess

    Grade 5 Cavernous sinus thrombosis


    Subperiosteal abscess
    Chandlers grade 3
    Orbital Cellulitis

    Rx : Systemic antibiotics
    Decongestants
    Analgesia

    URGENT ENT referral


    URGENT EYE referral
    URGENT CT sinuses
    THE EAR
    Otitis Externa - Features
    Discharge, pain, hearing loss,
    itching
    Commonest organisms:
    S Aureus
    Ps Aeruginosa
    Proteus
    Predisposing factors:
    Water
    Cotton buds
    Eczema
    Treatment:
    Topical antibiotics
    Aural toilet
    Analgesia
    Otitis Externa - Variants

    Malignant OE
    Fungal - Diabetes
    - VII palsy
    Malignant Otitis Externa

    Risk factor Diabetes


    Granulomatous polypoid otitis externa
    Disproportionately severe pain
    Associated features:
    Cranial nerve involvement VII, IX, X, XI, XII
    Treatment:
    Topical antibiotics and aural toilet
    i.v. antibiotics > 6/52
    Otitis Externa when to refer

    Refer if: Non responsive


    Canal oedematous
    Needs aural toilet
    Suspicion of malignant OE
    Acute Otitis Media

    Symptoms:

    Pain Discharge
    Hearing loss Pain subsides

    Rx : Systemic antibiotics
    Analgesia
    Decongestants
    Acute Otitis Media

    When to refer?
    Failure of resolution

    Persistent discharge

    Complications
    VII palsy
    Mastoiditis
    Acute Mastoiditis

    Features

    Recent URTI
    Ear discharge
    Blunting of postaural sulcus
    Fluctuant tender swelling
    Fever

    Rx : Systemic antibiotics
    Analgesia
    URGENT REFERRAL
    Perichondrial Haematoma

    Rx : Systemic antibiotics
    Analgesia
    URGENT REFERRAL for
    incision & drainage
    Perichondrial Cellulitis

    Rx : Systemic antibiotics
    Analgesia
    REFERRAL to ENT if no
    response after 24hr
    Cauliflower Ear
    Bead in ear

    Rx : one attempt at
    removal only.
    Try syringing with warm
    water
    Do not use forceps for
    round objects
    Non urgent ENT referral
    Insect in Ear

    Rx : Kill insect with


    olive oil
    Then try syringing with
    warm water
    Urgent ENT referral
    Bloody Otorrhoea

    Causes
    Otitis externa/media
    Trauma (local)
    Trauma (head injury)
    Postoperative
    Skull Base Fracture

    Rx : Do not examine ears with


    an auriscope.
    Admit under the head injury team
    Non urgent ENT referral
    Unless VII Palsy ENT
    EMERGENCY
    Case: Facial Palsy

    65yr old female


    3/52 history right facial
    weakness
    What are the key points
    that must be established
    in your clinical
    approach?
    Case: Facial Palsy

    Key points
    Establish whether UMN Forehead sparing = UMN
    or LMN

    Try and find a cause Thorough examination


    Facial nerve palsy - causes

    UMN (forehead sparing): CVA, MS, Ca


    LMN (complete):

    Intracranial Intratemporal Extracranial


    Acoustic neuroma Trauma Trauma
    G-Barre Acute otitis media Malignant parotid tumour
    TB Malignant otitis externa
    Neurosarcoid Ramsey-Hunt syndrome
    Glomus tumour SCC
    Lyme disease Cholesteatoma

    Idiopathic = Bells Palsy


    Facial Nerve Palsy (Bells)

    Rx : Prednisolone 30mg
    Acyclovir 200mg 5x/day
    Hypermellose eye drops
    Lacrilube ointment

    Red bulging ear drum =


    URGENT ENT review
    If not, Non urgent ENT review
    If poor eye closure =
    Ophthalmology review

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