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26 Cards in this Set
- Front
- Back
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epistaxis - source of anterior bleeds?
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Kiesselbach's plexus (Little's area)
= external carotid system |
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epistaxis - source of posterior bleeds?
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sphenopalatine a. branch
= internal carotid system |
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epistaxis - anterior bleed tx?
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1) remove existing clots
2) IDENTIFY BLEEDING SITE 3) topical lidocaine + phenylephrine 4) silver nitrate 5) anterior nasal packing + topical ABx ointment + phenylephrine |
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anterior nasal packing - cx? ppx?
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- TSS (Staph)
- sinusitis (blocked drainage) PPx: cephalexin or TMP/SMZ Remove after 3 days |
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epistaxis - posterior bleeds - tx?
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ENT c/s
- posterior packing - ADMIT TO HOSPITAL (monitor for hypoxia/apnea 2/2 nasopulmonary reflex) - if fails... sphenopalatine a. ligation / embolization |
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Kid brought in with unilateral, malodorous nasal discharge. - Dx?
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foreign body
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"Something stuck in my throat."
Normal exam. Next steps of mgmt (in order)? |
lateral radiographs of neck/chest
Gastrograffin esophagram esophagoscopy |
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Esophageal foreign body identified on XR.
Manage with glucagon? |
CONTRAINDICATED!
--| LES (may facilitate passing) ... BUT ... -->+ vomiting (PERFORATION!) |
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Which GI tract foreign bodies require retrieval?
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#1 = disc/button batteries!
>6.5 cm sharp fail to progress on serial AXRs |
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Patient with sinusitis returns to clinic with high fevers, proptosis, blurry vision or vision loss, and opthalmoplegia. Looks toxic.
Dx? |
cavernous sinus thrombosis
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Sinusitis - Indications for ABX?
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Sx > 7 days
...OR... Classic Sx: "double-sickening" after URI, upper tooth/face pain, purulent d/c |
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Sinusitis - Tx?
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Symptomatic:
- saline irrigation - vasoconstrictor nasal spray (<3 days) - nasal topical steroids AVOID antihistamines (can block ostia!) +/- ABx (amoxicillin, Augmentin, TMP/SMX for 10 days) |
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Sinusitis - when to refer to ENT?
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Fail 2 courses of ABx
Local complications (osteomyelitis, mucoceles) |
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Sinusitis - when to refer to ED?
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orbital complications: cellulitis, abscess
intracranial complications: cavernous sinus thrombosis, meningitis, subdural empyema, brain abscess DIABETIC or NEUTROPENIC pts |
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Adult epiglottitis - organisms?
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#1 = viral (Cx negative)
H. flu GABHS |
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Epiglottits - Tx?
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ABCs
2nd/3rd gen CSPN (cefotetan, cefoxitin) |
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otitis externa - organisms?
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Pseudomonas aeruginosa
MSSA MRSA |
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otitis externa - Tx?
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2% acetic acid (for drying) + hydrocortisone
topical Cortisporin solution (if intact TM) topical Cortisporin suspension (if perforated TM) |
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diabetic with ear pain
next step? |
CT or MRI
ADMIT Zosyn (anti-Pseudomonal) +/- debridement |
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peritonsillar / retropharyngeal abscess - organisms?
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anaerobes
GABHS MSSA MRSA H. flu |
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peritonsillar abscess - S/Sx?
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odynophagia, trismus, REFERRED OTALGIA
limited mouth opening (<2.5cm) muffled "hot potato" voice halitosis |
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peritonsillar abscess - risk factors?
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periodontal disease
smokers |
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peritonsillar abscess - tx?
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Needle aspiration --> ABX
Keep needle MEDIAL to avoid carotid artery! |
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retropharyngeal abscess - S/Sx?
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"neck pain out of proportion to exam" (oropharyngeal findings)
TOXIC-appearing neck in extension, RESIST flexion (mimics meningitis) |
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retropharyngeal abscess - Cx?
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direct extension along fascial plane --> mediastinitis
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retropharyngeal abscess - Dx? Tx?
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lateral neck radiograph
CT scan = #1 test of choice Secure airway IV ABx I&D |
