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13.02.28 ENT emergencies

Epistaxis

  • 3 areas
    • Anterior nasal cavity
    • Posterior nasal cavity
    • Superior nasal cavity
  • Blood supply:

  • Sites
    • 90% in Little's area => Usually self-limiting
    • 10% posterior cavity => More serious/hard to control
  • Management
    • Cauterise with silver nitrate
    • Pack
      • BIPP paste - Bismuth Iodoform Paraffin Paste (Astringent + antiseptic)
    • Foley catheter if posterior


Tonsillar bleed post-surgery

  • Usually 7-10 days post-surgery, in 1-2% of patients
  • May be herald bleed => Don't send home!
  • Usually infective => IV ABx


Foreign body
  • Don't try to remove unless you're very confident - You'll scare them for future attempts
  • Not usually urgent, except:
    • Batteries
    • Risk of asphyxia in nose


Ingested foreign body

  • Fish bones usually just scratch mucosa and go on down
  • Beware risk of perforation - e.g. chicken bones
    • Oesophagus
    • Mediastinum
  • X-ray
    • Usually doesn't help
    • Can't see fish bones etc
    • Batteries look like coins - Careful
    • Soft tissue >1/2 the width of vertebral bodies indicates oedema
  • Drugs to help it go down:
    • Buscopan 20 mg
    • Diazepam 2 mg
    • Fizzy drinks


Eerie

  • Otitis media
    • Bursting relieves pain
    • Keep dry, should heal by itself
  • Otitis externa
    • Oral ABx DON'T WORK!
    • Need topical
  • Cauliflower ear
    • Often H. influenzae
    • Ciprofloxacin


Mastoiditis
  • Spreads backwards from otitis media
  • Red, swollen behind ear
  • Pinna pushed down + forwards
  • Risk of spread to brain => Abscess


Nasal fracture

  • Xrays not useful
  • Risk of orbital ring fracture
    • Reduced periorbital sensation
    • Diplopia
  • Septal haematoma
    • Risk of perforation
    • Drain


Airway obstruction

  • Kids
    • Refer stridor straight to senior pediatricians
      • cf Epiglottitis (HIB) / Croup
    • Beware laryngospasm if disturbed: Don't make them cry with a venflon!
  • Adults
    • Think tumour
    • Oxygen, nebulised adrenaline, IV dexamethosone 8 mg
    • Heliox if available
  • Be ready for emergency tracheostomy if anesthetist fails to intubate


Tonsilitis

  • Need treatment if they can't eat/drink
  • Common viral cause = EBV (glandular fever)
    • => Exudative pharyngitis
    • Can get secondary bacterial infection
    • Monospot test
    • Rash with amoxicillin (false allergy)
    • Risk of systemic disease (do LFTs)
    • AVOID contact sports (risk of ruptured liver or spleen)


Peritonsillar abscess

  • Often unilateral
  • Big swelling pushes uvula over
  • Manage by drainage


Notes
  • Dangerous children
    • Beware slow onset of tachcardia/hypotension
    • You never know how much blood they're swallowed
    • => High index of suspicion in bleeds
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