facial, dental, ear, nose, and throat emergencies
DESCRIPTION
Facial, Dental, Ear, Nose, and Throat Emergencies. Sinusitis Bell’s Palsy Trigeminal Neuralgia. Facial Lacerations Soft Tissue Injuries Mandibular Fractures Maxillary Fractures Zygomatic Fractures. FACIAL EMERGENCIES. Dental Odontalgia Tooth Eruption Pericoronitis Fractures Tooth - PowerPoint PPT PresentationTRANSCRIPT
*Facial, Dental, Ear, Nose, and Throat Emergencies
*FACIAL EMERGENCIES
*Sinusitis*Bell’s Palsy*Trigeminal Neuralgia
*Facial Lacerations*Soft Tissue Injuries*Mandibular Fractures*Maxillary Fractures*Zygomatic Fractures
* DENTAL AND ENT EMERGENCIES
*Dental*Odontalgia*Tooth Eruption*Pericoronitis*Fractures Tooth*Subluxed/Avulsed Tooth*Dental Abscess*Ludwig’s Angina*Trench Mouth
*Ear*Acute OE*Acute OM*Ruptured Tympanic Membrane*FB*Meniere’s Disease*Labyrinthitis
* DENTAL AND ENT EMERGENCIES
*Nose*Rhinitis*Epistaxis*Nasal Fracture*FB
*Throat*Pharyngitis*Tonsillitis*Laryngitis*Fractured Larynx*Peritonsilar Abscess*FB
*FACIAL
*Assessment
*Nature of Injury/History*Bleeding*Airway Obstruction*Loss of Consciousness*Sensory Deficits/
Changes*Medical /Surgical History*Physical Assessment
*Assessment
*Psychosocial Responses*Stress Factors*Behavioral responses
*Assessment
*Diagnostic Procedures*Radiological*Facial Bones*Water’s View*Skull series*C-spine*CXR*CT
*Assessment
*Diagnostic Procedures*Laboratory*Cultures*Coags*ABGs*T&C
*Priorities
*ABC*Control Bleeding*Fluid and Electrolyte Balance*Prevent Further CNS complications*Control Pain*Relieve Anxiety*Education
*Age-related PearlsPediatric*6-7 year: primary eruption of teeth*Head is larger proportionally than adult’s*Neck muscles are relatively weaker for
large head mass*Always explain and be honest*Limitations in verbal expression*Facial bones are more pliable and softer
*Age-related PearlsGeriatric*Age-related changes*Decreased vital capacity*Diminished ability to cough*Visual acuity changes*Diminished hearing*Loss of short-term memory*Muscle atrophy
*Chronic Disease*Delayed responses*Medications
*Sinusitis
*Inflammation of mucous membranes*Maxillary sinus most common*Frequently follows URI*Other causes: *allergies* dental *infections *trauma*polyps
*Sinusitis
Symptoms*Pain/Pressure*Fever or not*HA*Decreased appetite*Nasal congestion*Nasal voice
*Red, swollen mucosa*Purulent nasal drainage*Conjunctivitis*Tenderness to palpation*Puffy eyes*Bad breath (esp. children)
*Sinusitis
Treatment*Decongestants*Antibiotics*HOB elevated*Apply heat*Room vaporizer*Severe: hospitalization
IV antibiotics Surgery
Education*Should improve 3-4 days*Vaporizer, steam bath*Increase fluids*Avoid smoking*“Rebound congestion”
*Bell’s Palsy
*Paralysis of all facial muscles on one side of face*Usually unilateral*Swelling of facial nerve as a result of virus
or immunodeficiency disease*> 40 yrs*Usually self-limiting*Complete resolution in 80-90% of cases
*Bell’s Palsy
Symptoms*Rapid, acute onset*Hx of Virus?*Unilateral facial
weakness/paralysis*Retro auricular and/or
facial discomfort*Drooling*Dysphagia
*Inability to close eye on affected side*Decreased lacrimation*Drooping of mouth*Speech difficulty*Positive corneal
sensation /negative blink*Inability to wrinkle
forehead
*Bell’s Palsy
*Diagnostics*Exclude other diseases
*Bell’s Palsy
*Treatment/Education*Explain this disease*Not a stroke*Recovery within 3 weeks*Artificial tears*Eye patch*Gentle manual closure of eye*Not contagious
*Keep face warm, avoid drafts*Possible analgesics and
steroids*Moist heat*Facial muscle exercises
*Trigeminal Neuralgia
*Fifth cranial nerve*Usually second and third division –
maxillary and mandibular areas*Brief, recurrent paroxysms of excruciating
facial pain*> 40 yrs and female*Right side affected more often
than left
*Trigeminal Neuralgia
Symptoms*Electrical shock type pain*Unilateral*Minimal to no sensory loss*Painful paroxysms precipitated by touching of trigger zone
Diagnosis*History and physical exam*Exclude other diseases
*Trigeminal Neuralgia
Treatment*Tegretol, Dilantin, analgesics*Surgical interventions
Education*Majority of patients respond
to medical therapy within 48 hrs*25-50% eventually will
require surgical intervention*Avoid cold exposure (iced
drinks, winds, swimming)*Side effects of medications
* Facial lacerations and soft tissue injuries
*Lacerations *Abrasions*Puncture wounds*Contusions*Avulsions*Range from simple isolated injury to those
accompanied by airway obstruction, edema, hemorrhage, facial trauma, and multisystem injuries
* Facial lacerations and soft tissue injuries
Symptoms/Assessment*MOI*Facial asymmetry/swelling*Pain/tenderness*Foreign bodies*Motor and sensory deficits
Diagnosis*Rule other S/S of more extensive facial injures, CNS injury, and multisystem injury*Radiographs*CT*Cultures
*Facial lacerations and soft tissue injuries
*Treatment*Control bleeding*Irrigate wounds copiously*Clean intact skin and wound edges*Replace tissue flaps*Td*Analgesics*Ice to area of trauma, not to avulsed part
*Suture*Anesthetic*Lido with epi unless contrindicated
*Restraint*Lighting*Scissors to cut hair / never shave or cut eyebrows
* Facial lacerations and soft tissue injuries
Education* Wound care
*Mandibular Fractures
*One of the most frequently fractured facial bone*TMJ dislocation may accompany*Fight and crashes most common causes
*Mandibular Fractures
Symptoms/Assessment*MOI*Pain/point tenderness*Malocclusion*Facial asymmetry*Bleeding around mouth*Numbness of lower lip*Trismus*Edema/hematoma
*Ruptured tympanic membrane*Mobility of fracture
fragments*Ecchymosis in floor of
mouth*Sunlingual edema
*Mandibular Fractures
Diagnostics*PA, lateral, oblique skull films*Waters’ *CT
*Mandibular FracturesTreatment*Ensure patent airway*Prevent aspiration of blood, teeth, bone fragments, etc*Control bleeding*Have emergency airway equipment readily available
Ice*Analgesics*Surgical reduction/wiring*Antibiotics*½ and ½ peroxide and
water*Td
*Mandibular Fractures
Education*S/S infection*Mechanical soft diet*Use a straw*Drink plenty of liquids
*Maxillary Fractures
*Less common than mandibular*Usually associated with other multisystem
injuries*LeFort I, II, III*Common causes: fight and crashes
*Maxillary Fractures
Symptoms/Assessment*MOI*Pain/tenderness*Swelling*Asymmetry/distortion*Infraorbital
mobility/paresthesia*Ecchymosis*Epistaxis
*Malocclusion*Visual disturbances*CSF rhinorrhea*Subconjuctival
hemorrhage*Midface maxillary
mobility*S/S of intracranial, spinal,
or multisystem injuries
*Maxillary Fractures
Diagnostics*Waters’ view*Individual facial films*CT scan
*Maxillary Fractures
Treatment/Education*Ensure airway patency*Prevent aspiration*Positioning – Fowler’s/Semi-Fowlers*Emergency intubation available*Control bleeding*Cold packs to face
*Definitive treatment*Open reduction*Internal wiring*Antibiotic prophylaxis*Hospital admission*Td*Support and reassurance
*Zygomatic Fractures
*Causes: Fight, Crash, and Falls*Tripod fractures*Frequently associated with orbital floor
fractures – blow-out fractures
*Zygomatic Fractures
Symptoms/Assessment*MOI*Pain/point tenderness*Bleeding*Edema*Pain with jaw movement*Visual disturbances/diplopia*Facial asymmetry
*Epistaxis*Subjunctival hemorrhage*Paresthesia of cheek, nose, upper lip of affected side*SQ emphysema
*Zygomatic Fractures
Diagnosis*Waters’ view*Submentovertical view
*Zygomatic Fractures
Treatment/Education*Analgesia*Position and elevate head*Ice
*Definitive treatment*Open reduction*Internal wire fixation*Hospital admission*Explanations and reassurance
*DENTAL AND ENT EMERGENCIES
*ASSESSMENT
History*Bleeding*Obstructed Airway*Swelling/Edema*Asymmetry/
Dislocation*Fever/Chills*Nausea/Vomiting*Drooling
*Facial numbness*Dysphasia/Dysphagia*Foul odor and taste in mouth*Loss of hearing*Tinnitis or vertigo*Trismus*Discharge/Drainage
*ASSESSMENT
*Itching*Neck pain*HA
*Medical History*HTN*CAD*Atherosclerosis*Neuro diseases*Dental/ENT surgery and/or infections*CA*Smoking*Diabetes
*DIAGNOSTICS
*Radiology*Chest*Waters’*CT scan
*Laboratory*Cultures*CBC*Sed rate*Coags*ABGs
*PRIORITIES
*ABCs*Control Bleeding*Fluid Volume*Pain control*Anxiety*Definitive Treatment*Prevent Complications*Education
*Age-Related Pearls
*Pediatric*85% of FB aspirations < 3 y/o* Boys twice as likely than girls
*Persistent cough or chronic wheezing may be indicative of aspirated FB
*In 20-38% of esophageal ingestions there are no symptoms*Abrupt onset of respiratory and pulmonary symptoms
suggest FB ingestion.
*Irritability and lack of feeding in infants may be potential S/S of ENT/Dental emergencies
*Age-Related Pearls
*Geriatric*Difficulty in mastication*Loss of sensation*Progressive hearing loss*Most dental and ENT emergencies in the
elderly is related to falls, visual changes, MVCs, and assaults
*Dental
*Odontalgia
*Toothache / Dental caries*Sharp to throbbing*If left untreated, will eventually lead to
necrosis*Prevention is best treatment
*OdontalgiaSymptoms*Pain in diseased tooth*May be referred to gum line, jaw, temple, ear, neck*More intense nocturnal pain*Heat or cold stimulus*Tooth discoloration*Foul breath
Diagnostics*Rule out abscess
*Odontalgia
Treatment*Topical anesthetic*Antibiotics*Analgesic
Education*Preventative hygiene*Follow-up with dentist
*Tooth Eruption
*Primary teeth in infants and children*Wisdom teeth
*Tooth Eruption
Symptoms*Pressure/Tenderness*Irritability/Agitation*Low-grade temp*Diarrhea*Refusal to eat or drink
*Nasal discharge*Crying*Drooling*Reddened, edematous tissue over erupting tooth*Rash around mouth
*Tooth EruptionTreatment*Gentle massage*Teething ring*Orajel*Tylenol/Ibuprofen*Warm saline mouth rinses*Soft solid diet
*Pericoronitis
*Erupting or impacted molars*Acute inflammation surrounds the gingival
tissue or crown of erupting tooth*Commonly seen in the 30 y/o adult*Complications: cellulitis, Ludwig’s angina,
and peritonsillar abscess
*PericoronitisSymptoms*Nonspecific diffuse extraoral pain or pain upon opening mouth*Earache on affected side*Sore throat, jaw pain*Unerupted third molar*Red, inflamed soft tissues around crown
*Lymphadenopathy, trismus and fever if has progressed to systemic
*Pericoronitis
Treatment/Education*Irrigate pericoronal flap with warm NS to remove debris*Refer to dentist for debridement or tooth extraction
*If infection:*Antipyretics*Antibiotic*Assist with drainage of abscess
*Fractured Tooth
*Common causes: Falls, MVCs, Physical abuse, Sport-related injuries, Seizures*Ellis Class I – *involve only the enamel, minor, rough appearance
*Ellis Class II *Enamel portion and the dentin*Pain sensitivities*Should be seen by dentist in 24hr
*Fractured Tooth
*Ellis Class III –*Enamel portion, dentin, and pulp*Dental Emergency
*Fractured ToothSymptoms/Assessment*MOI*Disfigurement of tooth/change in color*Pain/tenderness*Spontaneous*Hot or cold*Inspiration
*HA*N/V Involvement of enamel, dentin, pulp*Malocclusion*Bleeding*Intraoral or extraoral wounds
*Fractured Tooth
Treatment*Suspect and rule out other injuries*Fracture involving enamel and dentin*Apply Calcium Hydroxide to protect*Mild oral analgesic*Dental referral within 24 hrs*Antibiotics
*Fracture involving pulp*High risk of infection*Apply Calcium Hydroxide
to exposed crown surface*Oral analgesic*Dental referral for
pulpectomy
*Subluxed/Avulsed Tooth
Symptoms/Assessment*Pain at site *Bleeding*Neck pain*Respiratory status*Other wounds*Other injuries*Prevalent in ages 7-10
Treatment*Local anesthetic*Subluxed or partially avulsed
should be repositioned for stability*Avulsed must be replanted with
30 minutes (no longer than 6 hrs)*Clean mouth and socket with NS
or cold water*Tooth should be transported in
moist saline gauze or milk
*Subluxed/Avulsed Tooth
Education*Minimal mobility will
usually heal within 2 weeks*Soft diet*Avoid biting into anything
with affected tooth*Avoid hot and cold
substances*Refer to dentist or oral
surgeon
*Dental Abscess
*Localized accumulation of pus in a cavity of a tooth*Gingival swelling results from plaque and debris collecting
between tooth and gingiva*Peridontal disease results when infections spreads into
surrounding tissues and bone*Periapical abscess results when infections has spread
beyond the bone and the virus, bacteria has colonized
*Dental Abscess
Symptoms*Pain*May radiate to ear, jaw, and neck*Not relieved by analgesics*Swelling of face, neck, pharynx*Fever
*Bad breath*Malaise*Chills*Sore gums
Treatment*Systemic analgesic*Antipyretic*Assist with I&D (may leave drain in place)*Educate warm NS rinses every 1-2 hrs*Refer to dentist
*Dental Abscess
Diagnosis*Soft tissue X-ray*WBC*Culture
*Ludwig’s Angina
*Results from a secondary dental infection involving the lower second and third molars*Bilateral diffuse swelling and extending cellulitis
involving the submandibular, submental, and sublingual areas occurs*Difficulty talking and swallowing and breathing ensues
as the neck and face become swollen and causes elevation of the tongue
*Dyspnea*Pallor or cyanosis*Tachycardia*Agitation
*Ludwig’s AnginaSymptoms*Pain and swelling of jaw and neck*Fever/Chills*Malaise*Dysphagia*Dysphasia*Elevation of tongue and floor of mouth toward palate
*Ludwig’s Angina
Diagnosis*CBC*Sed rate*Soft tissue films*Cultures of exudate
*Ludwig’s Angina
Treatment*Maintain airway(emergency cric)*Fowler’s position*Oxygen*I&D (with culture)*Antibiotic
Education*Rinse mouth with warm NS 2-3 times every hour*Hot, moist compress to jaw and neck every hour
*Alveolitis
*a.k.a Dry Socket*Pain post extraction more than 2-3 days*Best treated with irrigation of the clot and
topical oral analgesia/anesthetic*Monitor for development of osteomyelitis
*Post-extraction Bleeding
*Small vessels that continue to bleed*Have patient bite on gauze over
extraction site for 30 minutes*May be anesthetized with lido with epi
and sutured*Avoid hard or hot foods
*Acute Necrotizing Ulcerative Gingivitis
*Trench Mouth*Non-contagious*May follow a URI*Also associated with debilitating illnesses, emotional
stressors, nutritional deficiencies, and smoking
*Acute Necrotizing Ulcerative Gingivitis
Symptoms/Assessment*Pain*Fever/Chills/Malaise*Bleeding gums*Poor oral hygiene*Fetid breath*Lymphadenopathy*Gray ulcers on pharyngeal structures
Treatment*Topical or local anesthetic*Antibiotics*Antipyretic*Refer to dentist*Teach proper oral hygiene
*EAR
*Acute Otitis Externa
*Swimmer’s Ear*Inflammation of external auditory canal
and auricle of the ear
*Acute Otitis Externa
Symptoms*Pain/Tenderness*Diminished hearing*Swelling/Redness/ Discharge*Pruritis*Low-grade fever*Fullness in ear*Cellulitis
*Acute Otitis Externa
Treatment*Topical antibiotic for one week*Cleaning debris out of ear with cotton tip applicator, suction
*Ear wick saturated with antibiotic and/or steroids when ear canal is acutely swollen*Hot, moist compress*Keep ear canal dry
*Acute Otitis Media
*Bacterial infection of middle ear*Causes: barotrauma, Eustachian tube
dysfunction, and URI*Swelling prevents effective drainage and
allows bacteria to proliferate*Commonly seen in infants and children
*Acute Otitis Media
Symptoms/Assessment*Earache that increases with prone position*Pulling at the ear*Sensation of fullness in ear*Decreased hearing*URI*Fever/Chills
*Anorexia*Vertigo/dizziness*Purulent nasal drainage*Erythema of pharynx*Erythema of TM*Retracted or bulging TM
*Acute Otitis Media
Treatment/Education*Antibiotic*Antipyretic*Analgesic*Follow-up within 2 weeks
*Ruptured Tympanic
Membrane
*Primarily caused by infection*May be caused from impact injury and
explosive acoustic trauma*Healing is usually spontaneous
*Ruptured Tympanic Membrane
Symptoms/Assessment*Pain*Bloody or purulent discharge*Vertigo*Tinnitus*Fever/Chills*Barotrauma
*Previous infection/illness*Slit-shaped or irregular TM*Decreased hearing in ear*Disequilibrium
*Ruptured Tympanic
Membrane
Treatment/Education*Antibiotic*Analgesic*Antipyretic*May need to assist in removing blood and debris from ear canal
*Avoid getting ear wet*Hydration*Follow-up
*Foreign Body In Ear*Commonly seen in adults*Avoid irrigating vegetable FBs*Mineral oil or 2% Lidocaine for insects
*Foreign Body In Ear
Symptoms/Assessment*Discomfort or pain*Decreased hearing*Swelling of external ear*Insect buzzing in ear*Agitation
*Foreign Body in Ear
Treatment/Education*Assist with removal*Irrigation*NS*Alcohol*Mineral oil*Lidocaine
*Suction*Use Flashlight for insect
*Meniere’s Disease
*Disorder of the vestibular system in the inner ear*Abnormal accumulation of fluid in the cochlea and
labyrinth causing severe rotary vertigo, N/V, and tinnitus*Commonly seen 40-60 y/o*Causes: blow to the head, infection, allergies, or
degeneration of the inner ear*Attack may last several hours
*Meniere’s Disease
Symptoms/Assessment*Rotational vertigo*Falls toward affected ear*N/V*Diaphoresis*Tinnitus*Hearing loss*Heightened sensitivity to sounds
*HA*Blurred vision*Moist, pale skin*Nystagmus*Rule out intracranial lesion*Hx of otitis media
Education* Safety R/T
vertigo, falling, meds
* Make position changes slowly
* Follow-up* Avoid alcohol and
caffeine * Hydration
*Meniere’s DiseaseTreatment
*Medications*Diuretics*Anti-emetic*Antihistamines*Vasodilator
*Bed Rest*Quiet environment*Surgery if severe and refractory to medical tx
*Labyrinthitis
*Inflammatory response of the inner ear; may involve nerves connecting the inner ear to the brain*Bacterial or Viral
*HA*Disequilibrium*Normal neuro exams*Orthostasis*Recent hx of ear infection, URI, viral illness
*Labyrinthitis
Symptoms/Assessment*Patient feels they are moving*Unsteadiness*N/V*Hearing abnormalities*Ear pressure
*Labyrinthitis
Treatment*Antihistamines*Antiemetics*Sedatives*IVF*Antibiotics
*NOSE
*Rhinitis
*Inflammatory condition of the nasal mucosa*Viral or bacterial URI*Spread by droplet contact
*Rhinitis
Symptoms/Assessment*Sneezing*Postnasal drip/Copious
nasal discharge*Nasal obstruction*Muscle aches*Malaise*HA*Water or itchy eyes
*Sore throat*Mild fever/chills*Inflammation of throat and
sinuses*Nasal mucosa
erythematous, edematous, and congested
*Rhinitis
Treatment/Education*Antipyretics*Decongestants*Antihistamines*Nasal corticosteroid*Hydration
*Teach to use nasal decongestants for only a few days*Symptoms usual resolve in
7 days
*Epistaxis
*Usually results from the erosion of superficial blood vessels from the anterior and inferior nasal septum*Causes: Nose-picking, FB, Nasal trauma,
Rhinitis, Forceful nose blowing*Anterior epistaxis usually treated with frim
pressure (pinching)*Posterior epistaxis requires nasal packing
*Epistaxis
Symptoms/Assessments*Bleeding*History of epistaxis*Recent trauma or surgery*N/V*Hx of aspirin and/or antiplatelets meds*Hx of HTN/atherosclerosis
*Erythema and swelling of nasal mucosa*Blood in auditory canal*Anxiety*Tachycardia*Sense of impending doom
*Epistaxis
Treatment/Education*ABCs*Control bleeding*Direct pressure*Nasal packing*Suctioning*Cauterization*Hemostatic material*Establish IV
*Medications*Anesthetic*Topical vasoconstrictors*Decongestant*Antihypertensives*Avoid blowing nose forcibly
*Nasal Fracture
*Most frequently fractured bone
*Nasal Fracture
Symptoms/Assessment*MOI*Visual deformity*Swelling*Nasal bleeding*Nasal obstruction*Crepitus*Pain/Tenderness*Rule out septum injury
Diagnosis*Nasal/facial films
*Nasal Fracture
Treatment/Education*Assess for other injuries*Control hemorrhage*Direct pressure*IV*Packing*Ice pack
*Medications*Anesthetic*Decongestant*Vasoconstrictor*Analgesic*Antibiotics
*Foreign Body In Nose*Commonly seen in children
*Foreign Body In Nose
Symptoms/Assessment*Nose pain/swelling*Nasal discharge*Foul smell from nose*Unilateral bleeding*Agitation
Treatment/Education*Blow nose to dislodge or remove*Topical vasoconstrictive*Assist in removal*Suction*Forceps*Foley catheter
*Throat
*Pharyngitis
*Sore Throat*Usually associated with viral URI*Most cases resolve with symptom
management*Spread by droplet transmission*Common during late fall, winter, early
spring*Strep
*Pharyngitis
Symptoms/Assessment*Sore throat*Difficulty swallowing*Pain referred to ears, neck, jaw*Fever/Chills*Harsh cough*Anorexia*Fatigue*Body aches
*Enlarged tonsils*Cervical lymphadenopathy*Exudate on pharynx and/or tonsils*Foul breath*Nasal speech*Flushed face
*Pharyngitis
Treatment/Education*Antipyretic*Analgesic*Steroids*Antibiotics*Warm saline irrigation*Rest*Hydration*Follow-up
*Tonsilitis
*Tonsils act as filters for lymphatic circulation*Similar to pharyngitis
*Tonsilitis
Symptoms/Assessment*Throat Pain*Recent URI*Pain/Difficulty swallowing*Referred pain*Fever/Chills*Fatigue*Fetid breath
*Tachycardia*Red and swollen tonsils*Purulent exudate on tonsils*Enlarged cervical and
submandibular lymph nodes*Flushed face*Culture (strep)
*Tonsilitis
Treatment/Education*ABC*Warm saline irrigation*Hydration (cool liquids)*Rest*Antibiotic*Antitussive*Steroids*Follow-up
*For chronic tonsilitis: tonsillectomy
*Laryngitis
*Hoarseness*Voice harsh and raspy*Commonly a viral infection*Constant urge to clear the throat or
tickling sensation
*Laryngitis
Symptoms/Assessment*Dry, tickling sensation in
throat*Partial to complete loss of
voice*Hoarseness*Fever/Chills*Sore throat*Dyspnea
*Difficulty swallowing*Dry cough*Anorexia*Reddened larynx and vocal
cords*Swelling of larynx and
epiglottis*Rhinorrhea*Throat cultures
*Laryngitis
Treatment/Education*Warm room that
humidified*Rest voice*Antibiotic*Inhaled steroid*Antitussive
*Antipyretic*Zinc*Ice to anterior throat*Humidifier
*Fractured Larynx
*Results from direct trauma (blunt or penetrating) to neck
*Common causes: MVC, strangulation, sports injuries
*Fractured Larynx
Symptoms/Assessment*MOI*Hoarseness*Change in voice*Pain on swallowing*Cough*Dyspnea*Hemoptysis
*Ecchymosis*Abrasions*SQ emphysema*Loss of normal prominence
of thyroid cartilage*Inspiratory stridor*Substernal or Intercostal
retractions
*Fractured Larynx
Diagnosis*CT scan*Rule out other injuries*Soft tissue films are not sensitive to laryngeal injury
Treatment*ABC / C-spine*Cric or trach*High humidity oxygen*ABGs*Treat concomitant injuries*Surgery
*Peritonsillar abscess
*Infection penetrating the tonsillar capsule and superior constrictor muscle into the surrounding areolar tissue*Streptococci bacteria are usually the
pathogen*Drainage of pus by an ENT
or oral surgeon provides immediate relief
*Peritonsilar abscess
Symptoms/Assessment*Sore throat*Pain on swallowing*Ear fullness*Fever/Chills*Pus / exudate on tonsils*Difficulty opening mouth*Drooling*Muffled voice
*Difficulty breathing*Enlarged affected tonsil*Displacement of uvula*Edema and erythema of
soft palate*Profuse salivation*Torticollis*Increases respiratory rate*Recent tonsilitis
*Peritonsillar abscess
Diagnosis*Culture and sensitivity
*Peritonsillar abscess
Treatment*ABC*Pulse OX*Oxygen*HOB 60 to 90°*IV hydration and medication
*Warm saline irrigation*Antibiotics Topical anesthetic*Analgesic*Antipyretic*Ice collar to throat*I&D
*Foreign Body In Throat
*Common cause of accidental death in US Children < 6 y/o*Can lead to obstruction of mainstem
bronchus or distal trachea*Airway management is priority*Heimlich maneuver and/or
abdominal thrusts
*Foreign Body In Throat
Symptoms/Assessment*Sore throat*Vocal changes*Drooling*Coughing*Difficulty swallowing
and/or breathing*Difficulty talking*Known ingestion
*FB visible in pharynx or larynx*Stridor*Tachycardia*Excessive salivation*Skin cool and moist*Hemoptysis*Hematemesis*Agitation
*Foreign Body In Throat
Diagnosis*PA and lateral CXR*Soft tissue of neck
*Foreign Body In Throat
Treatment/Education*ABC*Finger sweep*Heimlich*Oxygen*IV*HOB 60 to 90°
*Prepare for potential emergency intubation*Minimize environmental stimuli*Removal procedures*Balloon-tipped Foley*IVCS