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    ENT Emergency: James Paul O'Neill

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    kyliever
    This document provides an overview of key topics in ENT emergencies, including foreign body obstruction, epiglottitis, tonsillitis, nasal fracture, and mastoiditis. It discusses symptoms, causative organisms, examinations, and treatments for various ENT conditions. Importance is placed on history taking, physical examination skills, and recognizing life-threatening emergencies that require urgent referral.

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    ENT Emergency: James Paul O'Neill

    Uploaded by

    kyliever
    42 views43 pages
    This document provides an overview of key topics in ENT emergencies, including foreign body obstruction, epiglottitis, tonsillitis, nasal fracture, and mastoiditis. It discusses symptoms, causative organisms, examinations, and treatments for various ENT conditions. Importance is placed on history taking, physical examination skills, and recognizing life-threatening emergencies that require urgent referral.

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    ENT Emergencies

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    ENT Emergencies

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    This document provides an overview of key topics in ENT emergencies, including foreign body obstruction, epiglottitis, tonsillitis, nasal fracture, and mastoiditis. It discusses symptoms, causative organisms, examinations, and treatments for various ENT conditions. Importance is placed on history taking, physical examination skills, and recognizing life-threatening emergencies that require urgent referral.

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    Download as ppt, pdf, or txt
    42 views43 pages

    ENT Emergency: James Paul O'Neill

    Uploaded by

    kyliever
    This document provides an overview of key topics in ENT emergencies, including foreign body obstruction, epiglottitis, tonsillitis, nasal fracture, and mastoiditis. It discusses symptoms, causative organisms, examinations, and treatments for various ENT conditions. Importance is placed on history taking, physical examination skills, and recognizing life-threatening emergencies that require urgent referral.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 43

    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
    Welcome to the Dept of ENT
    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
    Emergencies

    Obstruction
    Infection
    Trauma
    Throat
    Obstruction

    Flies: ear should be filled with water or oil or lidocaine to


    kill the insect and remove it by forceps
    Foreign bodies: should be removed immediately
    Foreign Body
    Foreign body - throat
    Normal
    tonsils
    Acute Tonsillitis
    Acute Tonsillitis
    Viral Bacterial
    Causativ Adenovirus S. Pneumonia
    e Parainfluenza virus H. Influenza
    organism M. Catarrhalis
    s
    Mild sore throat, low Severe sore throat lasting >
    Symptom
    grade fever, mild 48 hours
    s
    adenopathy
    FBC
    Paul Bunnell test (test for detection of heterophil
    Dx
    antibodies in infectious mononucleosis)
    LFT: may cause liver toxicity
    Broad spectrum Abx
    (amoxicillin +/- Clavulanic
    acid)
    Analgesia
    Rx Bed rest
    Antipyretics
    Rehydration
    Acute Tonsillitis - Quinsy
    Definition:
    Peritonsillar abscess
    Pus collection between tonsillar capsule
    and the superior constrictor muscle
    Presentation:
    Severe sore throat, dysphagia,
    odynophagia
    Trismus (jaw locking)
    Hot potato voice
    Referred pain
    Causative organisms: S. aureus, S.
    pneumonia, Bacteroides
    Rx: Admit + IV Abx + drainage of the
    abscess
    Acute Tonsillitis tonsillectomy
    Indications:
    Tonsillitis: SIGN guidelines:
    Recurrent sore throats due to acute tonsillitis
    The episodes of sore throat are disabling
    7 episodes in the last 1 year
    5 episodes in each of last 2 year
    3 episodes in each of last 3 year
    Obstructive sleep apnoea
    Malignancy

    Complications:
    General: bleeding, anesthesia
    Specific: palatal dysfunction
    Epiglottitis
    Swallowing
    Epiglottitis
    Epiglottitis
    Children (1-6 yrs): emergency / life threatening!!! Due
    to risk of airway obstruction
    Adults: supraglottitis

    Symptoms
    High Fever
    Sore throat > unable to swallow saliva > saliva
    goes down to chin > unable to speak or swallow
    (plummy voice + dysphagia)
    Swelling of epiglottis
    Cant cough
    Dyspnoea
    NO COUGH!!
    Recent URTI
    Immobile, Sitting forwards, open mouth (drooling)

    Causative organism:
    Children: H Influenza type B (rare due to vaccine)
    Adults: Broad range of respiratory pathogens
    Epiglottitis
    Rx:
    Urgent ENT, peads and anaesthesia referral
    Admission
    Take to OR > intubation
    Then take to ICU > wait for 48 hours
    Then take back to OR and see if swelling in
    epiglottis subsided or not
    Oxygen
    Heliox (mix oxygen and helium)
    Adrenaline Nebulisers
    Steroids
    Antibiotics: 3rd generation cephalosporin
    (cefuroxime) for 2-3 days
    DO NOT: lye child down, examine throat or
    take a lateral x-ray
    Rifampicin: prophylaxis given to contacts
    Epiglottitis vs. 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 (lying
    down)
    Toxaemia Mild to severe Mild
    Cough None Barking, brassy
    Voice Muffled Hoarse
    Respiratory Rate Rapid Rapid
    Laryngeal palpation Tender Not tender
    Clinical course Rapid resolution Longer
    resolution
    Cricothyroidotomy
    Nose
    THE NOSE
    Obstruction

    One attempts to remove only


    Do not use forceps if round object
    Urgent referral to ENT
    Nasal fracture

    Rx:
    Analgesia
    Exclude other Max fax fractures and
    CSF rhinorrhea
    Refer if: obvious deformity or septal
    hematoma (urgent)
    Risk of cartilage necrosis
    Risk of abscess formation
    Rx:
    Bone manipulation: best time to
    manipulate it is within 5-7 days
    Rhinoplasty
    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
    90% from Littles area/ Kiesselbachs plexus
    Risk factors: URTIs, digital trauma, nose picking, allergic rhinitis
    Investigation if: weight loss, easy bruising, unilateral
    Adults:
    Traumatic
    Anterior bleed:
    Littles area (anastomosis of 4 arteries in anterior part of septum)
    Recurrent, self-limiting
    Posterior bleed:
    Elderly / Medical comorbidities (hypertension, aspirin, warfarin)
    More severe, need admission
    Most commonly from sphenopalatine artery
    Rx:
    Resuscitate
    FBC, Group and &X match, Platelets
    BP
    IV Line
    Control bleeding with:
    Cautery: Silver nitrate cautery
    Nasal Packing (for minimum 48 hours): BIPP: Bismuth Iodoform Paraffin Paste, Merocel, Rapid Rhino
    Embolization (angiography)
    How NOT to pack a nose!!!
    Ear
    THE EAR
    Emergencies include:

    Otitis externa and malignant otitis externa


    Acute otitis media
    Acute mastoditis
    Perichondrial Haematoma
    Mastoiditis
    Perichondrial Haematoma

    Rx :
    Systemic antibiotics
    Analgesia
    URGENT REFERRAL for incision &
    drainage to prevent development
    of cauliflower ear
    Perichondrial Haematoma Cauliflower ear

    Loss of blood
    supply to cartilage
    > loss of cartilage
    > loss of normal
    structure of ear
    Ear thickened or
    deformed
    Cause: repeated
    blows (boxing or
    rugby)
    Bloody otorrhea

    Causes:
    Otitis externa/media
    Trauma (local or
    head injury)
    Post-op
    Precautions

    Primary
    surveillance

    Secondary
    surveillance

    Radiology

    Head injury team


    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
    Forehead sparing = UMN
    UMN or LMN

    Try and find a cause Thorough examination


    Facial Nerve Palsy (Bells)

    Red bulging ear drum =


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

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