Common ENT emergencies Basic management How to refer Cases you should not miss On call team 0875 0709 For patients who need to be reviewed in ENT OPD within next few days refer to RAC clinic ID: 1032181
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1. ENT EMERGENCIESM AL-HASHIM
2. Common ENT emergenciesBasic management How to referCases you should not miss
3. On call team 0875, 0709For patients who need to be reviewed in ENT OPD within next few days; refer to RAC clinicRAC clinic Otitis externa, Bells palsy, FBs , Nose bleed, sudden hearing loss
4. Rhinology (Nose)EpistaxisFractured noseForeign body in NoseAcute sinusitisOrbital cellulities
5. EpistaxisCommonest emergencyPrimarySecondaryWarfarinAspirinTraumaMedical/HaematologicalAnterior or Posterior Bleed
6. Epistaxis
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8. ManagementDepends on presentationABC Clear the airway, Stop the bleeding, Maintain circulationClear the airwayGood position with adequate lightProtect yourselfRemove clots with suctionApply co-phenylcaine
9. Epistaxis
10. Stop the BleedingApplication of external pressure/application of ice packCautery for Anterior bleeding (Avoid in HHT)Nasal packing for posterior bleeding or a failed cautery
11. Epistaxis
12. Cautery Prominent vessels on anterior septumApply co-phenlycaineCauterise with silver nitrate stickApply naseptin cream to area (14 days)
13. PackingProfuse bleeding preventing cauterizationFailed cauterization Posterior bleeding
14. Insertion of Rapid Rhino
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17. It Hurts!
18. Criteria for admissionPatients requiring a nasal pack with the followingUncontrolled bleeding/posterior bleedRecent nasal surgerySignificant blood loss/shockMajor cardiac/respiratory diseaseElderly/infirm/poor social circumstancesPatients on warfarinBilateral nasal packUnilateral nasal pack in a fit patient: Discharge review after 24 hours to remove the pack
19. Fractured Nose
20. Fractured NoseClinical diagnosisX-ray not necessaryIf nose is bleeding external pressure will suffice in most casesExclude septal haematomaAssess for clinical deformityIf obvious arrange ENT follow up within 5-7days
21. Septal Haematoma
22. Deviated Septum
23. Foreign Body in NoseChildren, Refer to ENTCo-operative patient remove with wax hook. Only one attempt allowed in A/ENon co-operative frightened patient refer to ENT On Call, same day
24. Foreign bodiesNasal FB
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26. Periorbital Cellulitis= Pre-septalOrbital cellulitis= septalPrevious history of sinusitisRecent URTI , nasal dischargeLimited eye movement, Painful eye movement, visual defectS Pneumonia, H influenzae, Staph aureus,Anaerobes. Analgesia, IV Abs, CT, Ophthalmology Surgical drainage for abscess
27. Pre septal & Post septalPost septal infectionProptosis & Chemosis
28. Otology Acute Infections otitis externa & mediaTraumaLaceration not involving cartilageLaceration involving cartilageHaematoma of pinnaPerforation of tympanic membraneForeign bodyFacial nerve palsyAcute dizziness (vomiting, absence of neurological signs)Sudden hearing loss
29. Otitis Externa
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31. Management Otitis externa/mediaAnalgesiaExternaTopical preparation (Gentisone HC, Sofradex)Insertion of Pope wick for closed canalIf canal is filled with debris arrange for ENT follow-up for aural toiletSevere case refer to ENT On Call ( A&E Doctors)MediaOral antibioticsArrange ENT Review
32. Otitis Externa
33. Facial nerve PalsyLower Motor neuron facial palsyIf spares the forehead, refer to the physician Bells palsyRamsay Hunt SyndromeAcute otitis mediatrauma
34. Bell’s palsy Sudden With/without otalgia55% of facial palsyTreatment:Eye careSteroid? Anti virus
35. Ramsay Hunt SyndromeBlisters/Painful rash +facial weakessTinnitus, dizziness, Sensory neural hearing loss, loss of tasteAnalgesia, Steroid, Antiviral
36. Facial palsy from ear infectionsAcute otitis media with or without ear dischargeUrgent ENT referralIV Abs May require immediate surgical interventionChronic otitis mediaSurgical treatmentOtitis Externa MalignantDiabetes, pseudomonas outer ear infection, temporal bone necrosis + cranial nerve palsiesSurgical debridement, Abs for 6 months
37. TraumaticTemporal bone fracture ( Ear CSF, blood): Neurosurgery Facial injury: Maxillofacial or plastic
38. Acute DizzinessDD Acute stroke Dizziness is a symptom of stroke in 50% of stroke presentations.A small stroke of the cerebellum or brain stem can present with isolated dizziness.CT is not sensitive, MRI is not practical at A&E setting
39. Dizziness in A&EENT?physician
40. Acute Dizziness1.Vestibular neuritisBad symptoms for ~2 days2.BPPVLast less than 1 minuteFeel normal in between or slightly dizzy3.Meniere’s diseaseSever dizziness for 20miutes or moreNausea / vomitingTinnitusPressure in the earRecurrent
41. Peripheral signsHorizontal unidirectional nystagmusPositive Head Thrust TestWhen the head is moved quickly in one direction, the reflex (i.e., the VOR) that moves the eyes toward the opposite direction is generated by the side the head moved toward. Thus a patient with vestibular neuritis of the left side will present with right-beating unidirectional nystagmus and have a positive head thrust test with movements toward the left sideCentral signsTortional, Bidirectional, downbeating Nystagmus
42. Mastoiditis
43. Mastoiditis
44. Perichondrial HaematomaFollows blunt injury to the earCollection of blood between auricular cartilage and perichondrium of pinnaRequired drainage and compressionIf left untreated – cauliflower ear
45. HaematomaAspiration + pressure bandageIncision and drainage
46. F.B EarNot urgentAdults: Microscope Arrange a RAC clinicSmall children often require GA
47. The Larynx/PharynxSore throat/Tonsillitis/Glandular feverEpiglotittisIngested foreign bodyNeck trauma
48. Sore ThroatAcute tonsillitisGlandular FeverPeritonsillitisQuinsyEpiglottitis (Dysphgia, Drooling, No signs)
49. Acute Tonsillitis
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52. ManagementSore Throat/TonsillitisAnalgesia/?AntibioticsRefer to On Call ENT if:Peritonsillar abscessInability to swallow due to pain
53. EpiglottisNormally fit patientSudden onset of difficulty swallowingMay be droolingOropharynx looks unremarkableUrgent ENT referral Ceftriaxone
54. Head lightLocal AnaestheticsTongue depressor, ? Scope ? mirror
55. Food bolusABCDysphagia, gagging Admission, IV fluid, ? BescopnReferral for OGD FB Oesophagus :Sharpe object( bone), Kids (coin), sever discomfort Direct oesophagoscopy under GA
56. Post tonsillectomy painUncontrolled with usual medicationCannot swallowAdmit, Iv fluid, Analgesia including Oromorph solution
57. Post tonsillectomy bleeding-Iv Canula,-Fluid,Nil by mouth, Iv Abs, Analgesia,Blood tests including G&S.
58. Do not missSever sore throat with no physical signsNose bleed in young patients, far east Unilateral middle ear infections in adultsNose bleed, recent adenotonsillectomyNot treating the eyes in Bell’s palsyFacial weakness after mastoid or ear infectionsChild with unilateral nasal dischargeDiabetic patient with recurrent otitis externa
59. Thank You