Common ENT casualties / emergencies and management strategies
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This document provides an overview of common ENT emergencies and casualties that general practitioners may encounter. It discusses acute airway obstruction, otology issues like otitis externa and media, rhinologic emergencies including epistaxis, and various head and neck problems such as tonsillitis, peritonsillar abscess, and foreign bodies. Management strategies are outlined for these conditions. The document concludes with asking for feedback on the educational lecture via text message.
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Common ENT casualties / emergencies and management strategies
- 1. DR. MTD LAKSHAN MBBS(Col), MS(ORL), DOHNS (UK), FEB (ORL–HNS), FRCS Ed (ORL-HNS) Consultant ENT and Head and Neck Surgeon DGH Hambantota Common ENT Emergencies / Casualties
- 3. •Acute Emergency - Air Way Obstruction •Casualties/Emergencies –Otology –Rhinology –Head and Neck Outline
- 4. Air Way Obstruction Stridor / Stertor
- 5. Airway Adequacy •Clinical (best) –Respiratory Rate, –Stridor, –Recessions, –Pulse rate –Cyanosis •ABG, Pulse Oxymetry (Secondary)
- 6. GP Training Lecture – Tissa – May 2013 Management •Call for help - Anaesthetists, ENT –Support airway ABC –O2, Nebulisations, steroids –Heliox •Airway Interventions –Cricothyroidotomy, ETT –Tracheostomy
- 7. Otology
- 8. GP Training Lecture – Tissa – May 2013 Otology •Otitis Externa •Otitis Media / Mastoiditis •FB in Ear •Sudden Deafness •Facial Nerve Palsy •Trauma •Perichondrial haematoma /cyst /cellulitis
- 9. Normal TM
- 10. Otitis Externa •Symptoms –Pain –Itching –Discharge •Signs –Canal Oedema, Tenderness –Scales, Wet Blotting Paper –Fungi - Aspergillus flavus, A. niger
- 11. Otitis Externa
- 12. Otitis Externa
- 13. Otitis Externa
- 14. Otitis Externa •Suction clearance - EUM •Analgesia •Ear Drops •Advice •Any cause?
- 15. Otitis Media Child Pain, Irritable, Pulling / Rubbing Ear Hearing loss Fever RTI Bulging Red TM Otorrhoea CHL Management Analgesia Antibiotics -controversial
- 16. GP Training Lecture – Tissa – May 2013 Otitis Media
- 17. Acute Mastoiditis •ENT Referral •IV AB •May need CT +/- Mastoidectomy
- 19. Perichondrial Haematoma Urgent ENT referral Early I & D Antibiotics Risk : Cauliflower Ear
- 20. Cauliflower ear
- 21. Perichondritis Systemic AB Analgesia ENT referral Risk : Cauliflower Ear
- 22. FB Ear Good Illumination Proper Instruments Expertise Microscope Remember “first attempt is the best attempt” Non-Urgent ENT referral
- 23. Insect in Ear Drown the insect with Olive Oil, water Syringe? Urgent ENT referral
- 24. Sudden Deafness •Emergency •Needs Admission •Causes: –Vascular, –Viral, –Autoimmune, –CP angle mass(rare) •Hx, Ear Exam, Neurological Exam
- 25. Sudden Deafness •Inner Ear Test Battery –FBC, –ESR, –FBS, –Lipid Profile, –TSH, –VDRL •serial PTA •MRI
- 27. LMN Facial Nerve Palsy Not all - Bell’s –Ear –Parotid –Paraphayrngeal –Skull Base –Temporal Bone Trauma • note the onset – with the trauma or delayed
- 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-urgent ENT review.
- 29. Rhinology
- 30. Rhinology •Epistaxis •FB •Nasal Bone fracture •Septal Haematoma •Orbital Cellulitis
- 31. Epistaxis •Common •Three Principles 1.Arrest Bleeding 2.Resuscitation 3.Find the cause •Anterior vs Posterior •bleeding point •management
- 32. Arrest Bleeding
- 33. Management •Hx - PMx, Trauma, Nasal Symptoms •Ex - ABC - Anterior Rhinoscopy –Nasal Endoscopy •Ix - FBC, Clotting Profile, G&S •Fluids •Epistaxis Ladder
- 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. Options
- 36. Fracture of Nasal Bones MUA window 5 days - two weeks Not early due to swelling Not later - bony fusion No deformity, No septal Haematoma --> No intervention If deformity/ Not sure -> OPA 4-5 days
- 37. Septal Haematoma Early Evacuation Surgical To prevent saddle nose deformity
- 38. Orbital Cellulitis Emergency Colour Vision, Eye Movements General Illness Urgent CT Ophthalmology/ENT Opinion Need IV Broad spectrum May need early Surgery
- 39. FB Nose •Childhood •Unilateral Discharge •Good Illumination •Proper instruments •First attempt = best attempt •May Need GA •Batteries - EMERGENCY
- 40. Head and Neck
- 41. Head and Neck •Tonsillitis •Peritonsillar Abscess •Post tonsillectomy bleed •Epiglottitis •FB - throat
- 42. Tonsillitis •Fever, Odynophagia •O/E Bilaterally inflamed •Analgesia •Antipyretics •Antibiotics •If unable to swallow, ill –Admit for IV
- 43. Quinsy •Asymmetry •Worsening of Symptoms –Trismus •I&D / Aspiration
- 44. Epiglottitis 1st URGENT - Anaesthetic Ref. 2nd URGENT - ENT Ref. 3rd URGENT - Paed. Ref. Rx : DO NOT TOUCH KID! Oxygen Adrenaline Nebulisers Heliox Steroids Antibiotics
- 45. GP Training Lecture – Tissa – May 2013 FB 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. FB
- 47. Summary •Upper airway obstruction •Mastoiditis •Orbital Cellulitis •Septal Haematoma •Pinna haematoma •Epistaxis •Otitis Externa •Tonsillitis / Quinsy
- 48. SMS A,B,C,D 0712 117 383 In managing a patient with quinsy what is the best option? A.Oral antibiotics for 5 days B.Intravenous antibiotics C.Incision and drainage D.Aspiration E.Do nothing
- 49. SMS A,B,C,D 0712 117 383 A patient presents with sudden deafness. What is the most appropriate management option? A.IV antibiotics B.Refer to the out patients department C.Steroids D.Arrange an urgent MRI Scan E.Give 48 hours to see whether it self improves
- 50. SMS A,B,C,D 0712 117 383 What is the best mangement option for a perichondrial cyst? A.Aspiration B.Incision and drainage C.Pressure D.Usually settles without any treatment E.Secondary to infection
- 51. SMS A,B,C,D 0712 117 383 Stridor A.Can be due to obstruction at palatal level B.Epiglotitis is caused by influenza C.Cutaneous and airway haemangioma are not related D.In Pierre Roban sequence micrognathia is a feature E.Tracheostomy is the last resort
- 52. SMS A,B,C,D 0712 117 383 Was the lecture useful? A.Yes (Great!) B.Yes (OK) C.No D.Utter waste of my valuable time!