ENT emergency


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  • Stem cells are “non-specialized” cells that have the potential to form into other types of specific cells, such as blood, muscles or nerves. They are unlike 'differentiated' cells which have already become whatever organ or structure they are in the body. Stem cells are present throughout our body, but more abundant in a fetus.
    Medical researchers and scientists believe that stem cell therapy will, in the near future, advance medicine dramatically and change the course of disease treatment. This is because stem cells have the ability to grow into any kind of cell and, if transplanted into the body, will relocate to the damaged tissue, replacing it. For example, neural cells in the spinal cord, brain, optic nerves, or other parts of the central nervous system that have been injured can be replaced by injected stem cells. Various stem cell therapies are already practiced, a popular one being bone marrow transplants that are used to treat leukemia. In theory and in fact, lifeless cells anywhere in the body, no matter what the cause of the disease or injury, can be replaced with vigorous new cells because of the remarkable plasticity of stem cells. Biomed companies predict that with all of the research activity in stem cell therapy currently being directed toward the technology, a wider range of disease types including cancer, diabetes, spinal cord injury, and even multiple sclerosis will be effectively treated in the future. Recently announced trials are now underway to study both safety and efficacy of autologous stem cell transplantation in MS patients because of promising early results from previous trials.
    Research into stem cells grew out of the findings of two Canadian researchers, Dr’s James Till and Ernest McCulloch at the University of Toronto in 1961. They were the first to publish their experimental results into the existence of stem cells in a scientific journal. Till and McCulloch documented the way in which embryonic stem cells differentiate themselves to become mature cell tissue. Their discovery opened the door for others to develop the first medical use of stem cells in bone marrow transplantation for leukemia. Over the next 50 years their early work has led to our current state of medical practice where modern science believes that new treatments for chronic diseases including MS, diabetes, spinal cord injuries and many more disease conditions are just around the corner. For more information please visit http://www.neurosurgeonindia.org/
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  • There was a lacking of the specific medications to be used in the above mentioned conditions. I think it was just an outline.
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  • excellent presentation, thanks on behalf of my junior medical staff.
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  • how wonderful!! thanks !!
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ENT emergency

  1. 1. ENT Emergencies Stanford University Division of Emergency Medicine
  2. 2. Overview <ul><li>Otologic Disorders </li></ul><ul><li>Nasal Disorders </li></ul><ul><li>Facial, Oral and Pharyngeal Infections </li></ul><ul><li>Airway Obstruction </li></ul>
  3. 3. Otologic Disorders Anatomy <ul><li>Auricle </li></ul><ul><li>Ear canal </li></ul><ul><li>Tympanic membrane </li></ul><ul><li>Middle ear and mastoid disorders </li></ul><ul><li>Inner Ear </li></ul>
  4. 4. Traumatic Disorders of the Auricle <ul><li>Hematoma </li></ul><ul><li>- cartilaginous necrosis </li></ul><ul><li>- drain, antibiotics, bulky ear dressing close follow up </li></ul><ul><li>Lacerations - single layer closure, pick up perichondrium, bulky ear dressing </li></ul><ul><li>Use posterior auricular block for anesthesia </li></ul>
  5. 5. Aspiration of Auricular Hematoma
  6. 6. Auricle <ul><li>Chondritis - Cellulitis ? </li></ul><ul><li>- infectious, difficult to treat because poor blood supply, cover S. Aureus and pseudomonas </li></ul><ul><li>- extra care in diabetics </li></ul><ul><li>- inflammatory causes related to seronegative arthritis at times indistinguishable from infection usually the ear lobe is spared </li></ul>
  7. 7. Otitis Externa <ul><li>Infection and inflammation caused by bacteria (pseudomonas, staph), and fungi </li></ul><ul><li>- treat with antibiotic-steroid drops </li></ul><ul><li>- use wick for tight canals </li></ul><ul><li>- diabetics can get malignant otitis externa (defined by the presence of granulation tissue) </li></ul>
  8. 8. Foreign Bodies in Ear Canal <ul><li>Usually put in by patient, some bugs fly in </li></ul><ul><li>kill bugs with mineral oil, or lidocaine </li></ul><ul><li>remove with forceps, suction or tissue adhesive </li></ul>
  9. 9. Tympanic Membrane Perforation <ul><li>Hard to see – Hx of drainage </li></ul><ul><li>Usually from middle ear pressure secondary to fluid or barotrauma </li></ul><ul><li>Sometimes from external trauma </li></ul><ul><li>most heal uneventfully but all need otology follow-up </li></ul><ul><li>perfs with vertigo and facial nerve involvement need immediate referral </li></ul><ul><li>treat with antibiotics </li></ul><ul><li>drops controversial but indicated for purulent discharge (avoid gentamycin drops) </li></ul>
  10. 10. Middle Ear <ul><li>Serous Otitis Media - Eustachian tube dysfunction - treat with decongestants, decompressive maneuvers </li></ul><ul><li>Otitis Media - infection of middle ear effusion - viral and bacteria </li></ul><ul><li>Mastoiditis - Venous connection with brain, need aggressive treatment (can lead to brain abcess or meningitis) </li></ul>
  11. 11. Inner Ear <ul><li>peripheral vertigo (vestibulopathy) </li></ul><ul><li>BPV, labyrhinthitis </li></ul><ul><li>- acute onset, no central signs, usually young, horizontal nystagmus </li></ul><ul><li>Meniere’s - vertigo, sensorineural hearing loss, tinnitus </li></ul><ul><li>Treatment </li></ul><ul><li>- valium, fluids, rest, manipulation for BPV </li></ul>
  12. 12. The Nose <ul><li>Vascular Supply </li></ul><ul><li>- Anterior - branches of internal carotid </li></ul><ul><li>- Posterior - distal branches of external carotid </li></ul>
  13. 13. Epistaxis Anterior <ul><li>90% (Little’s Area) Kisselbach’s plexus - usually children, young adults </li></ul><ul><li>Etiologies </li></ul><ul><li>Trauma, epistaxis digitorum </li></ul><ul><li>Winter Syndrome, Allergies </li></ul><ul><li>Irritants - cocaine, sprays </li></ul><ul><li>Pregnancy </li></ul>
  14. 14. Epistaxis Posterior <ul><li>10% of all epistaxis - usually in the elderly </li></ul><ul><li>Etiologies </li></ul><ul><li>Coagulopathy </li></ul><ul><li>Atherosclerosis </li></ul><ul><li>Neoplasm </li></ul><ul><li>Hypertension (debatable) </li></ul>
  15. 15. Epistaxis Management <ul><li>Pain meds, lower BP, calm patient </li></ul><ul><li>Prepare ! (gown, mask, suction, speculum, meds and packing ready) </li></ul><ul><li>Evacuate clots </li></ul><ul><li>Topical vasoconstrictor and anesthetic </li></ul><ul><li>Identify source </li></ul>
  16. 16. Epistaxis Management <ul><li>Anterior Sites </li></ul><ul><li>- Pressure +/- cautery and/or tamponade </li></ul><ul><li>- all packs require antibiotic prophylaxis </li></ul>
  17. 17. Epistaxis Posterior Packing <ul><li>Need analgesia and sedation </li></ul><ul><li>require admission and 02 saturation monitoring </li></ul>
  18. 18. Epistaxis Complications <ul><li>severe bleeding </li></ul><ul><li>hypoxia, hypercarbia </li></ul><ul><li>sinusitis, otitis media </li></ul><ul><li>necrosis of the columella or nasal ala </li></ul>
  19. 19. 7th Nerve Palsy <ul><li>Most cases are idiopathic </li></ul><ul><li>- link to HSV </li></ul><ul><li>- no proof steroids or antivirals are effective, but many advocate </li></ul><ul><li>Consider Lyme’s Disease in edemic areas </li></ul><ul><li>Surgical decompression indicated in the rare patient not improving by 2 weeks and ENOG out > 90% </li></ul>
  20. 20. Facial Infections Sinusitis <ul><li>Signs and symptoms </li></ul><ul><li>- H/A, facial pain in sinus distribution </li></ul><ul><li>- purulent yellow-green rhinorrhea </li></ul><ul><li>- fever </li></ul><ul><li>- CT more sensitive than plain films </li></ul><ul><li>Causative Organisms </li></ul><ul><li>- gram positives and H. flu (acute) </li></ul><ul><li>- anaerobes, gram neg (chronic) </li></ul>
  21. 21. Facial Infections Sinusitis <ul><li>Treatment </li></ul><ul><li>acute - amoxil, septra </li></ul><ul><li>chronic - amoxil-clavulinic acid, clindamycin, quinolones </li></ul><ul><li>decongestants, analgesia, heat </li></ul><ul><li>Complications </li></ul><ul><li>ethmoid sinusitis - orbital cellulits and abcess </li></ul><ul><li>frontal sinusitis - may erode bone (Potts Puffy Tumor, Brain Abcess) </li></ul>
  22. 22. Facial Cellulitis <ul><li>Most common strept and staph, </li></ul><ul><li>Rarely H.Flu </li></ul><ul><li>Can progress rapidly </li></ul>
  23. 23. Parotiditis <ul><li>Usually viral </li></ul><ul><li>-paramyxovirus </li></ul><ul><li>Bacterial </li></ul><ul><li>- elderly, immunosuppressed </li></ul><ul><li>- associated with dehydration </li></ul><ul><li>- cover - Staph, anaerobes </li></ul>
  24. 24. Pharyngitis <ul><li>Irritants </li></ul><ul><li>-reflux, trauma, gases </li></ul><ul><li>Viruses </li></ul><ul><li>- EBV, adenovirus </li></ul><ul><li>Bacterial </li></ul><ul><li>-GABHS, mycoplasma, gonorrhea, diptheria </li></ul>
  25. 25. Peritonsillar Abcess <ul><li>Complication of suppurative tonsillitis </li></ul><ul><li>Inferior - medial displacement of tonsil and uvula </li></ul><ul><li>dysphagia, ear pain, muffled voice, fever, trismus </li></ul><ul><li>Treatment </li></ul><ul><li>- Antibiotics, I&D, +/-steroids </li></ul>
  26. 26. Epiglottitis Clinical Picture <ul><li>Older children and adults </li></ul><ul><li>decrease incidence in children secondary to HIB vaccine </li></ul><ul><li>Onset rapid, patients look toxic </li></ul><ul><li>prefer to sit, muffled voice, dysphagia, drooling, restlessness </li></ul>
  27. 27. Epiglottitis <ul><li>Avoid agitation </li></ul><ul><li>Direct visualization if patient allows </li></ul><ul><li>soft tissue of neck </li></ul><ul><li>- thumb print, valecula sign </li></ul><ul><li>Prepare for emergent airway, best achieved in a controlled setting </li></ul><ul><li>Unasyn, +/- steroids </li></ul>
  28. 28. Epiglottitis
  29. 29. Retropharyngeal Abcess <ul><li>Anterior to prevertebral space and posterior to pharynx </li></ul><ul><li>Usually in children under 4 (lymphoid tissue in space) </li></ul><ul><li>pain, dysphagia, dyspnea, fever </li></ul><ul><li>swelling of retropharyngeal space on lateral x-ray </li></ul><ul><li>Complications - mediastinitis </li></ul>
  30. 30. Masticator - Parapharyngeal Space Infection <ul><li>Infection of the lower molars invade masticator space </li></ul><ul><li>Swelling, pain fever, TRISMUS </li></ul><ul><li>Treatment </li></ul><ul><li>IV antibiotics (PCN or Clindamycin) </li></ul><ul><li>ENT admission </li></ul>
  31. 31. ANUG Acute Necrotizing Ulcerative Gingivitis <ul><li>Bacterial infection causing an acute necrotizing, destructive disease of periodontium </li></ul><ul><li>Treatment </li></ul><ul><li>- oral rinses </li></ul><ul><li>- antibiotics (PCN, clindamycin, tetracycline) </li></ul>
  32. 32. Ludwigs Angina <ul><li>Rapidly progressive cellulitis of the floor of the mouth </li></ul><ul><li>usually in elderly debilitated patients and precipitated by dental procedures </li></ul><ul><li>massive swelling with impending airway obstruction </li></ul><ul><li>Treatment </li></ul><ul><li>ICU, antibiotics, airway management </li></ul>
  33. 33. Angioedema <ul><li>Ocassionally life threatening </li></ul><ul><li>Heriditary and related to ACE inhibitors </li></ul><ul><li>Antihistamines, steroids and doxepin </li></ul>
  34. 34. Airway Obstruction <ul><li>Aphonia - complete upper airway </li></ul><ul><li>Stridor - incomplete upper airway </li></ul><ul><li>Wheezing - incomplete lower airway </li></ul><ul><li>Loss of breath sounds- complete lower airway </li></ul>
  35. 35. Questions and Answers