Anda di halaman 1dari 37

BLOK EMERGENCY

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