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