Alexander ch30 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 30
Disorders of the Eye,
Ear, Nose, Throat,
and Oral Cavity

• Applies fundamental knowledge to provide basic
and selected advanced emergency care and
transportation based on assessment findings for
an acutely ill patient.
Advanced EMT
Education Standard

1. Define key terms introduced in this chapter.
2. Describe the etiology and pathophysiology of conditions
of the eye.
3. Develop a list of differential diagnoses for patients
presenting with eye complaints.
4. Develop a treatment plan for patients presenting with an
eye problem in the prehospital setting.
of the ear.
Objectives (1 of 3)

6. Develop a list of differential diagnoses for patients
presenting with ear complaints.
7. Develop a treatment plan for patients presenting with ear
complaints in the prehospital setting.
of the nose and sinuses.
9. Develop a list of differential diagnoses for patients with
nasal complaints.
10.Describe the etiology and pathophysiology of conditions
of the oropharynx and throat.
Objectives (2 of 3)

11.Develop a list of differential diagnoses for patients with
indications of problems of the throat and oropharynx.
12.Develop a treatment plan for patients presenting with
problems of the nose, throat, or oropharynx in the
prehospital setting.
Objectives (3 of 3)

• AEMTs must have basic understanding of
disorders that affect eyes, ears, nose, oral cavity,
and throat.
• Threat of loss of one of those senses is frightening
for patients.
Introduction

Think About It
• What are some potential causes of the patient’s
presentation?
• Under what circumstances could eye pain present
a time-critical emergency?
• What questions and assessments will help Charlie
and Ben determine the nature of the underlying
problem?

Figure 30-1
Anatomy of the eye.

Anatomy and Physiology Review (1 of 8)
• The eyes
– Vision is provided by special receptor cells in eye.
– Bony orbits of skull and accessory structures (eyelids,
eyelashes, tear ducts) protect eye.
– Hollow globe with two fluid-filled chambers
– Vitreous humor gives eye shape and maintains position
of retina.

• The eyes (continued)
– Fibrous layer
 White sclera and clear cornea
– Vascular layer
 Includes circular, pigmented iris
– Retina
 Neural layer; outgrowth of brain that is connected to brain’s
visual centers
– Rods are very light sensitive but not color sensitive.
– Cones are color sensitive.

Figure 30-2
Anatomy of the ear.

• The ears
– Inner ear
 Allows for equilibrium and hearing
– Pinna (outer ear)
 Directs sound waves into external auditory canal
– Cerumen
 Protects ear canal from small foreign objects and pathogens
– Tympanic membrane (eardrum)
 Separates external auditory canal from middle ear

• The ears (continued)
– Middle ear
 Filled with air and communicates with nasopharynx by way
of auditory tube
– Eustachian tubes
 Allow equalization of pressure between middle ears and
atmosphere
– Auditory cortex in temporal lobe of brain permits
recognition and interpretation of sounds.
 Damage to auditory cortex impairs ability to understand or
make sense of sounds.

Figure 30-3
Anatomy of the nose.

• The nose
– Respiratory functions
 Warming, humidifying, filtering air
– Organ of olfaction or smell.
 Odorant molecule binds to receptor cell.
 Transmitted to CNS by olfactory nerve.
 Nerve transmission stimulates hypothalamus and limbic
system.

• The oral cavity
– Part of airway and digestive system
– Digestive functions:
 Taste, mechanical breakdown of food and complex
carbohydrates
– Lips, cheeks, hard and soft palates, oropharynx,
tongue, gums, teeth
– Taste buds on tongue

• The oral cavity (continued)
– 20 primary teeth replaced by 32 secondary teeth
– Enamel covers crown and neck of tooth; crown extends
above gum line.
– Root section extends into bone of jaw.

Figure 30-5
The pharynx and tonsils.

• The throat
– Divided into three regions
 Nasopharynx
 Oropharynx
 Hypopharynx
– Three sets of tonsils in pharynx
 Pharyngeal
 Palatine
 Lingual

Assessment and Management (1 of 2)
• Complaints can be diverse.
– Pain, swelling, loss of function in affected area,
dizziness, headache, nausea, vomiting, infection
(fever, malaise)
 Distressing when patients experience sudden loss of
hearing or seeing
 Swelling can lead to airway obstruction.
– Consider analgesia according to protocols.
– Follow assessment guidelines.

Assessment and Management (2 of 2)
• Be particularly concerned with the airway in
patients with complaints that involve the oral
cavity and throat.
• Swelling can lead to complete airway obstruction.
• In severe cases, endotracheal intubation or
cricothyrotomy is necessary.

Disorders of the Eye (1 of 3)
• Conjunctivitis
– Inflammation of conjunctiva of eye, pink or red
bloodshot appearance
• Hordeolum (sty)
– Ducts of glands along margin of eyelid become
infected
• Orbital and periorbital cellulitis
– Serious bacterial infections of tissues around eye

• Foreign bodies
– Irritate cornea and conjunctiva, becoming embedded
in cornea, or by penetrating globe
– Do not attempt to remove embedded foreign objects
or objects impaled in eye globe in prehospital setting.
• Glaucoma
– Increase in intraocular pressure can damage optic
nerve; leads to blindness if not treated.

• Sudden partial or total loss of vision, in one or
both eyes, is very a serious condition.
– Stroke
– Retinal artery occlusion
– Detached retina
– Migraine headaches

Disorders of the Ear (1 of 3)
• Otitis externa
– Inflammation or infection of external auditory canal
• Otitis media
– Inflammation or infection of middle ear
• Labyrinthitis
– Inflammation of inner ear, viral or bacterial infections,
other inflammatory processes

• Ménière disease and Ménière syndrome:
– Increased pressure that disrupts mechanoreceptors
of inner ear; problems with balance and vertigo
• Foreign bodies in ear are most common in
pediatric population.
– Do not attempt to remove foreign objects from ear in
prehospital setting.

• New-onset causes of hearing loss
– Ear infection
– Inner ear disturbance
– Exposure to loud noise
– Ruptured tympanic membrane
– Cerumen impaction (accumulation of ear wax)
– Foreign body in ear
– Blow to the head

Disorders of the Nose (1 of 3)
• Epistaxis (nosebleed) can occur spontaneously
or as result of trauma.
– Trauma to nasal mucosa
– Nasal mucosa is dry.
– Bleeding can be significant.
– Pinch nostrils together firmly to control bleeding.
– Instruct patient not to swallow blood.

• Epistaxis, or nosebleed, can be exacerbated by:
– Medications that interfere with platelet function or
coagulation
– Hypertension
– Underlying medical problems, such as hepatic disease
or hemophilia

• Foreign bodies in nose are common in pediatric
population.
– Do not attempt removal in prehospital setting.
• Sinusitis
– Occurs after upper respiratory system infection or in
conjunction with seasonal allergies

Disorders of the Oral Cavity and Throat
(1 of 2)
• Pain in tooth and jaw arise from:
– Myocardial infarction, ear infection, sinus infection
• Painful dental problems:
– Cavities, abscess, cracked or broken teeth, gum
disease
• Abscess: infection in pulp cavity of tooth
• No specific prehospital treatment for dental pain.

Disorders of the Oral Cavity and Throat
(2 of 2)
• Epiglottitis
– Bacterial infection caused by Haemophilis influenza
type B (Hib)
• Peritonsillar abscess
– Infection in capsule surrounding palatine tonsils caused
by streptococcal and staphylococcal bacteria
• Diphtheria
– Bacterial infection and contagious disease; contact with
pseudomembrane or respiratory droplets particularly
infectious

Chapter Summary (1 of 2)
• Disorders of eye, ear, nose, throat, oral cavity can
be painful and distressing for patients.
• Be aware of problems that are life threatening or
threaten loss of special senses.
• Particular concern: conditions that cause airway
obstruction or lead to sepsis.

Chapter Summary (2 of 2)
• Loss of sight, hearing, or vertigo can have other
causes, such as stroke.
• Use focused approach to history and assessment.
• Provide reassurance to patient.
• Consider need for intravenous fluids and
analgesia.

Alexander ch30 lecture

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Alexander ch30 lecture