DR. MTD LAKSHANMBBS(Col), MS(ORL), DOHNS (UK),FEB (ORL–HNS), FRCS Ed (ORL-HNS)Consultant ENT and Head and Neck SurgeonDGH ...
SCOPE – ORL-HNS
•Acute Emergency - Air Way Obstruction•Casualties/Emergencies–Otology–Rhinology–Head and NeckOutline
Air Way ObstructionStridor / Stertor
Airway Adequacy•Clinical (best)–Respiratory Rate,–Stridor,–Recessions,–Pulse rate–Cyanosis•ABG, Pulse Oxymetry (Secondary)
GP Training Lecture – Tissa – May 2013Management•Call for help - Anaesthetists, ENT–Support airway ABC–O2, Nebulisations, ...
Otology
GP Training Lecture – Tissa – May 2013Otology•Otitis Externa•Otitis Media / Mastoiditis•FB in Ear•Sudden Deafness•Facial N...
Normal TM
Otitis Externa•Symptoms–Pain–Itching–Discharge•Signs–Canal Oedema, Tenderness–Scales, Wet Blotting Paper–Fungi - Aspergill...
Otitis Externa
Otitis Externa
Otitis Externa
Otitis Externa•Suction clearance - EUM•Analgesia•Ear Drops•Advice•Any cause?
Otitis MediaChildPain, Irritable,Pulling / Rubbing EarHearing lossFeverRTIBulging Red TMOtorrhoeaCHLManagementAnalgesiaAnt...
GP Training Lecture – Tissa – May 2013Otitis Media
Acute Mastoiditis•ENT Referral•IV AB•May need CT +/- Mastoidectomy
Acute Mastoiditis
Perichondrial HaematomaUrgent ENT referralEarly I & DAntibioticsRisk : Cauliflower Ear
Cauliflower ear
PerichondritisSystemic ABAnalgesiaENT referralRisk : Cauliflower Ear
FB EarGood IlluminationProper InstrumentsExpertiseMicroscopeRemember “first attempt is the bestattempt”Non-Urgent ENT refe...
Insect in EarDrown the insect withOlive Oil, waterSyringe?Urgent ENT referral
Sudden Deafness•Emergency•Needs Admission•Causes:–Vascular,–Viral,–Autoimmune,–CP angle mass(rare)•Hx, Ear Exam, Neurologi...
Sudden Deafness•Inner Ear TestBattery–FBC,–ESR,–FBS,–Lipid Profile,–TSH,–VDRL•serial PTA•MRI
Management•Bed Rest•Steroids•Acyclovir•Carbogen•Betahistine
LMN Facial Nerve PalsyNot all - Bell’s–Ear–Parotid–Paraphayrngeal–Skull Base–Temporal Bone Trauma• note the onset– with th...
Management•Treat the cause•Idiopathic–Steroids 1mg/kg for 10d tapering–Acyclovir 200mg 5/d 1 w–Eye Care• Hypermellose eye ...
Rhinology
Rhinology•Epistaxis•FB•Nasal Bone fracture•Septal Haematoma•Orbital Cellulitis
Epistaxis•Common•Three Principles1.Arrest Bleeding2.Resuscitation3.Find the cause•Anterior vs Posterior•bleeding point•man...
Arrest Bleeding
Management•Hx - PMx, Trauma, NasalSymptoms•Ex - ABC - Anterior Rhinoscopy–Nasal Endoscopy•Ix - FBC, Clotting Profile, G&S•...
Epistaxis ladder• Pressure, Ice• Cautery with Silver Nitrate• Anterior Packing - Merocel, Rapid-rhino, BIPP• Posterior Pac...
Options
Fracture of Nasal BonesMUA window 5 days - twoweeksNot early due to swellingNot later - bony fusionNo deformity, No septal...
Septal HaematomaEarly EvacuationSurgicalTo prevent saddle nose deformity
Orbital CellulitisEmergencyColour Vision, Eye MovementsGeneral IllnessUrgent CTOphthalmology/ENT OpinionNeed IV Broad spec...
FB Nose•Childhood•Unilateral Discharge•Good Illumination•Proper instruments•First attempt = bestattempt•May Need GA•Batter...
Head and Neck
Head and Neck•Tonsillitis•Peritonsillar Abscess•Post tonsillectomy bleed•Epiglottitis•FB - throat
Tonsillitis•Fever, Odynophagia•O/E Bilaterally inflamed•Analgesia•Antipyretics•Antibiotics•If unable to swallow, ill–Admit...
Quinsy•Asymmetry•Worsening of Symptoms–Trismus•I&D / Aspiration
Epiglottitis1st URGENT - Anaesthetic Ref.2nd URGENT - ENT Ref.3rd URGENT - Paed. Ref.Rx : DO NOT TOUCH KID!OxygenAdrenalin...
GP Training Lecture – Tissa – May 2013FB throat•Soft - may settle with buscopan, diazepam,fizzy drink•Sharp–small --> tons...
FB
Summary•Upper airway obstruction•Mastoiditis•Orbital Cellulitis•Septal Haematoma•Pinna haematoma•Epistaxis•Otitis Externa•...
SMS A,B,C,D0712 117 383In managing a patient with quinsy what is thebest option?A.Oral antibiotics for 5 daysB.Intravenous...
SMS A,B,C,D0712 117 383A patient presents with sudden deafness. Whatis the most appropriate management option?A.IV antibio...
SMS A,B,C,D0712 117 383What is the best mangement option for aperichondrial cyst?A.AspirationB.Incision and drainageC.Pres...
SMS A,B,C,D0712 117 383StridorA.Can be due to obstruction at palatal levelB.Epiglotitis is caused by influenzaC.Cutaneous ...
SMS A,B,C,D0712 117 383Was the lecture useful?A.Yes (Great!)B.Yes (OK)C.NoD.Utter waste of my valuable time!
Thank YouAny Questions?
Upcoming SlideShare
Loading in …5
×

Common ENT casualties / emergencies and management strategies

7,563 views
6,968 views

Published on

Common ENT ( Otorhinolaryngology and Head and Neck Surgery) casualty / emergency management plans. email queries at "info at learnent.net"

Published in: Health & Medicine
0 Comments
36 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,563
On SlideShare
0
From Embeds
0
Number of Embeds
434
Actions
Shares
0
Downloads
0
Comments
0
Likes
36
Embeds 0
No embeds

No notes for slide

Common ENT casualties / emergencies and management strategies

  1. 1. DR. MTD LAKSHANMBBS(Col), MS(ORL), DOHNS (UK),FEB (ORL–HNS), FRCS Ed (ORL-HNS)Consultant ENT and Head and Neck SurgeonDGH HambantotaCommon ENTEmergencies / Casualties
  2. 2. SCOPE – ORL-HNS
  3. 3. •Acute Emergency - Air Way Obstruction•Casualties/Emergencies–Otology–Rhinology–Head and NeckOutline
  4. 4. Air Way ObstructionStridor / Stertor
  5. 5. Airway Adequacy•Clinical (best)–Respiratory Rate,–Stridor,–Recessions,–Pulse rate–Cyanosis•ABG, Pulse Oxymetry (Secondary)
  6. 6. GP Training Lecture – Tissa – May 2013Management•Call for help - Anaesthetists, ENT–Support airway ABC–O2, Nebulisations, steroids–Heliox•Airway Interventions–Cricothyroidotomy, ETT–Tracheostomy
  7. 7. Otology
  8. 8. GP Training Lecture – Tissa – May 2013Otology•Otitis Externa•Otitis Media / Mastoiditis•FB in Ear•Sudden Deafness•Facial Nerve Palsy•Trauma•Perichondrial haematoma /cyst /cellulitis
  9. 9. Normal TM
  10. 10. Otitis Externa•Symptoms–Pain–Itching–Discharge•Signs–Canal Oedema, Tenderness–Scales, Wet Blotting Paper–Fungi - Aspergillus flavus, A. niger
  11. 11. Otitis Externa
  12. 12. Otitis Externa
  13. 13. Otitis Externa
  14. 14. Otitis Externa•Suction clearance - EUM•Analgesia•Ear Drops•Advice•Any cause?
  15. 15. Otitis MediaChildPain, Irritable,Pulling / Rubbing EarHearing lossFeverRTIBulging Red TMOtorrhoeaCHLManagementAnalgesiaAntibiotics-controversial
  16. 16. GP Training Lecture – Tissa – May 2013Otitis Media
  17. 17. Acute Mastoiditis•ENT Referral•IV AB•May need CT +/- Mastoidectomy
  18. 18. Acute Mastoiditis
  19. 19. Perichondrial HaematomaUrgent ENT referralEarly I & DAntibioticsRisk : Cauliflower Ear
  20. 20. Cauliflower ear
  21. 21. PerichondritisSystemic ABAnalgesiaENT referralRisk : Cauliflower Ear
  22. 22. FB EarGood IlluminationProper InstrumentsExpertiseMicroscopeRemember “first attempt is the bestattempt”Non-Urgent ENT referral
  23. 23. Insect in EarDrown the insect withOlive Oil, waterSyringe?Urgent ENT referral
  24. 24. Sudden Deafness•Emergency•Needs Admission•Causes:–Vascular,–Viral,–Autoimmune,–CP angle mass(rare)•Hx, Ear Exam, NeurologicalExam
  25. 25. Sudden Deafness•Inner Ear TestBattery–FBC,–ESR,–FBS,–Lipid Profile,–TSH,–VDRL•serial PTA•MRI
  26. 26. Management•Bed Rest•Steroids•Acyclovir•Carbogen•Betahistine
  27. 27. LMN Facial Nerve PalsyNot all - Bell’s–Ear–Parotid–Paraphayrngeal–Skull Base–Temporal Bone Trauma• note the onset– with the trauma or delayed
  28. 28. Management•Treat the cause•Idiopathic–Steroids 1mg/kg for 10d tapering–Acyclovir 200mg 5/d 1 w–Eye Care• Hypermellose eye drops–Physiotherapy•OPA– ENT urgent if TM / parotid abnormal, If not, non-urgentENT review.
  29. 29. Rhinology
  30. 30. Rhinology•Epistaxis•FB•Nasal Bone fracture•Septal Haematoma•Orbital Cellulitis
  31. 31. Epistaxis•Common•Three Principles1.Arrest Bleeding2.Resuscitation3.Find the cause•Anterior vs Posterior•bleeding point•management
  32. 32. Arrest Bleeding
  33. 33. Management•Hx - PMx, Trauma, NasalSymptoms•Ex - ABC - Anterior Rhinoscopy–Nasal Endoscopy•Ix - FBC, Clotting Profile, G&S•Fluids•Epistaxis Ladder
  34. 34. Epistaxis ladder• Pressure, Ice• Cautery with Silver Nitrate• Anterior Packing - Merocel, Rapid-rhino, BIPP• Posterior Packing–Proprietary PNS balloons–Foley’s Catheter–OT• Arterial Ligation–Sphenopalatine, ant. ethmoidal, maxillary, Ext.Carotid
  35. 35. Options
  36. 36. Fracture of Nasal BonesMUA window 5 days - twoweeksNot early due to swellingNot later - bony fusionNo deformity, No septalHaematoma --> NointerventionIf deformity/ Not sure -> OPA4-5 days
  37. 37. Septal HaematomaEarly EvacuationSurgicalTo prevent saddle nose deformity
  38. 38. Orbital CellulitisEmergencyColour Vision, Eye MovementsGeneral IllnessUrgent CTOphthalmology/ENT OpinionNeed IV Broad spectrumMay need early Surgery
  39. 39. FB Nose•Childhood•Unilateral Discharge•Good Illumination•Proper instruments•First attempt = bestattempt•May Need GA•Batteries -EMERGENCY
  40. 40. Head and Neck
  41. 41. Head and Neck•Tonsillitis•Peritonsillar Abscess•Post tonsillectomy bleed•Epiglottitis•FB - throat
  42. 42. Tonsillitis•Fever, Odynophagia•O/E Bilaterally inflamed•Analgesia•Antipyretics•Antibiotics•If unable to swallow, ill–Admit for IV
  43. 43. Quinsy•Asymmetry•Worsening of Symptoms–Trismus•I&D / Aspiration
  44. 44. Epiglottitis1st URGENT - Anaesthetic Ref.2nd URGENT - ENT Ref.3rd URGENT - Paed. Ref.Rx : DO NOT TOUCH KID!OxygenAdrenaline NebulisersHelioxSteroidsAntibiotics
  45. 45. GP Training Lecture – Tissa – May 2013FB throat•Soft - may settle with buscopan, diazepam,fizzy drink•Sharp–small --> tonsils, tongue base, epiglottis• Visualise and remove–larger --> pyriform sinus, oesophagus•GA - Oesophagoscopy
  46. 46. FB
  47. 47. Summary•Upper airway obstruction•Mastoiditis•Orbital Cellulitis•Septal Haematoma•Pinna haematoma•Epistaxis•Otitis Externa•Tonsillitis / Quinsy
  48. 48. SMS A,B,C,D0712 117 383In managing a patient with quinsy what is thebest option?A.Oral antibiotics for 5 daysB.Intravenous antibioticsC.Incision and drainageD.AspirationE.Do nothing
  49. 49. SMS A,B,C,D0712 117 383A patient presents with sudden deafness. Whatis the most appropriate management option?A.IV antibioticsB.Refer to the out patients departmentC.SteroidsD.Arrange an urgent MRI ScanE.Give 48 hours to see whether it self improves
  50. 50. SMS A,B,C,D0712 117 383What is the best mangement option for aperichondrial cyst?A.AspirationB.Incision and drainageC.PressureD.Usually settles without any treatmentE.Secondary to infection
  51. 51. SMS A,B,C,D0712 117 383StridorA.Can be due to obstruction at palatal levelB.Epiglotitis is caused by influenzaC.Cutaneous and airway haemangioma are notrelatedD.In Pierre Roban sequence micrognathia is afeatureE.Tracheostomy is the last resort
  52. 52. SMS A,B,C,D0712 117 383Was the lecture useful?A.Yes (Great!)B.Yes (OK)C.NoD.Utter waste of my valuable time!
  53. 53. Thank YouAny Questions?

×