EM E2: ENT

What is the tx for a style or chalazion?

warm compress → erythromycin ointment → doxycycline → optho referral if unresolved after 4-6 weeks

What is the tx for bacterial conjunctivitis?

ocular abx 4xd x 7 days (FQ, Gent, Tobra, Sulfa)

*contact lens → use FQ

What is the tx for allergic conjunctivitis?

cool compresses, antihistamines, decongestant drops, artificial tears PRN

What is the tx for viral conjunctivitis?

cool compresses, Naphcon-A one drop 3-4x/d

What would be seen upon fluorescein dye of viral conjunctivitis?

multiple tiny dots of stain uptake

What would be seen upon fluorescein staining of HSV keratitis?

dendritic lesions

What is the tx for HSV keratitis?

initial outbreak involving the lids: oral Acyclovir or Famvir

HSV w/ corneal involvement: Viroptic drops, Erythromycin ointment

refer to ophtho in 24-48 hrs

Which

What would you see on slit-lamp examination of Herpes Zoster ophthalmicus?

iritis

What is a sign of Herpes Zoster ophthalmicus?

Hutchinsons sign (lesions on tip of the nose)

What is the tx for Herpes Zoster Ophthalmicus?

Acyclovir, Famvir, or Valcyclovir; Bacitracin or Erythromycin for cutaneous lesions, analgesic; Prednisolone acetate for iritis

*consider admission and IV acyclovir

What are sx of Periorbital cellulitis?

edematous, warm, red eyelids; acuity, pupillary reaction, EOMs maintained

What is the tx for periorbital cellulitis?

Augmentin

severe w/ early EOM involvement: admit for IV abx (Ceftriaxone + Vanc)

What is the most frequent source of orbital cellulitis?

polymicrobial paranasal sinus infection

What are sx of orbital cellulitis?

impaired EOMs, pain, fever, ocasionally proptosis, dec VA

What is the tx of orbital cellulitis?

CT and admit

Vanc IV + Ceftriaxone or Cefotaxime

What causes subconjunctival hemorrhage?

mild trauma, sneezing, coughing, vomiting, HTN

What is the tx for subconjunctival hemorrhage?

none

what is the tx for conjunctival abrasion?

erythromycin ointment

What would be seen on a fluorescein stain of a corneal abrasion?

linear abrasions

What is the tx for corneal abrasion?

Erythromycin ophthalmic ointment, eye patch, optho referral

What is the tx for conjunctival FB?

removed w/ a moistened cotton-tipped applicator

What is the tx for corneal FB?

topical anesthetic prior

full-thickness: optho consult

superficial: removed w/ 30-25 gauge needle uner slit-lamp

erythromycin ointment ± patching

What are sx of a blowout fx?

enophthalmos (post displacement of eyeball w/in orbit), impaired ocular motility, diplopia, infraorbital hypesthesia

What is seen on an XR of blowout fx?

depression of bony fragments into max. sinus, emphysema of orbit, clouding of maxillary sinus on side of trauma

What is the tx for a blowout fx?

optho, plastics, OMFS, ENT consult

*can delay surgery to watch for spontaneous repair; repair if diplopia or enophthalmos persists

Keflex QID x 10 days

What drugs cause tinnitis?

NSAIDs, select abx

What causes sudden hearing loss (< 3 days)?

idiopathic (MC), infection, vascular, trauma, ototoxic drugs

What is necessary if PE does not identify the cause of sudden hearing loss?

emergent otolaryngologic

What is the tx for acute otitis externa?

analgesia, cleansing, acidifying agents, topical antimicrobials, ± steroids

What is the tx for malignant otitis externa?

Peds: Imipenum

Adults: Aminoglycoside, antipseudomonal PCN, Cephalosporin, or quinolone

severe: IV abx and surgical debridement

What is malignant otitis externa?

persistent OE despite topical abx tx (usually in elederly, diabetic, HIV w/ OE) (form of osteomyelitis)

What do you need to monitor for w/ malignant otitis media?

CN 7 paralysis (CN 9, 10 , & 11 is a serious sign) & trismus

What causes malignant otitis external?

P. aeruginosa, MRSA

What causes mastoiditis?

strep. pneumonia (complication of otitis media)

What is the dx study for mastoiditis?

CT mastoids

What is the tx for mastoiditis?

Ceftriaxone or Levaquin IV for 1st episode → Vanc and Zosyn or Imipenum

ENT consult for I&D or mastoidectomy

What is the tx for ear FB?

removal w/ cerumen loops, right-angle hook, or alligator forceps; drown live objects w/ 2% lidocaine solution; irrigate w/ warm water

*complete inspection after removal

What is the MCC of impetigo?

S. aureus adn Group A Strep pyogenes

What is thet x for impetigo?

topical Mupirocin ointment

*MRSA: TMS or Clinda

What causes Erysipelas?

S. pyogenes

What is the tx for Erysipelas?

Augmentin, Azithromycin, Keflex, Clindamycin, Dicloxacillin

What is the tx for cellulitis?

*caused by GAS & S. aureus

analgesics, antipyretics, broad spec abx

What is the tx for viral parotitis (mumps)?

supportive

What abn labs will you seen w/ mumps?

elevated amylase levels

What causes suppurative parotitis?

S. aureus (can be potentially fatal)

What is the tx for suppurative parotitis?

Augmentin, Clindamycin, Keflex/Flagyl combo

*admit for IV if trismus, cannot tolerate PO, immunocompromised, failure of outpt tx (48hr)

How do the majority of Sialolithiasis stones present?

80% U/L and submandibular, pain, swelling, tender

*exacerbated by meals

What is the tx for sialolithiasis?

analgesics, massage, sialologues, abx for secondary infection

What imaging is needed for TMJ dysfunction or fracture?

acute trauma: panaromaic xray view of mandible

CT for complex fx

What is the tx for TMJ dysfunction or fracture?

oral maxillofacial surgeon consult

chronic: soft foods, analgesics

What imaging is need for TMJ dislocation?

XR to r/o condylar fx

What is the tx for TMJ dislocation?

conscious sedation for reduction + IV diazepam or midazolam; get post reduction films

*if still pain → admit + occlusal fixation otherwise d/c on NSAIDs and soft diet

Where do majority of anterior nosebleeds originate from?

Kiesselbach plexus

What is the tx for anterior epistaxis?

direct pressure; may need Neosyn (vasoconstrictive), cautery, nasal packing

*use Keflex or Augmentin if packed

Where do most posterior epistaxis originate from?

spenopalatine artery

What is the tx for posterior epistaxis?

posterior nasal packing or ballooning; analagesics, admit pt

abx: Augmentin or Keflex if packing > 48 hr

What is the MC site for a nasal fx?

bridge of nose

What is the necessary workup for a nasal fx?

CT scan

What is the tx for a nasal fx?

admit + consult based on CT; may need ENT or plastic surgeon

What is the tx for nasal fx?

control bleeding, tx septal hematoma;

gross deformity w/o edema, f/u 5-7 days

What are sx of nasal FB?

sensation of U/L nasal obstruction, persistent foul-smelling rhinorrhea despite proper abx tx, persistent u/l epistaxis

What is the tx for a nasal FB?

prepare nasal mucosa w/ vasoconstrictors and anesthetics, remove via positive pressure, suction catheter, forceps, or passing catheter beyond and pulling out

What is considered acute sinusitis?

< 4 wks duration

What is considered chronic sinusitis?

> 12 wks duration

What are sx of acuter bacterial sinusitis?

> 7 days, sinus pain or tenderness, purulent nasal secretions

What is the tx for acute sinusitis?

sx tx, OTC nasal decongestants or antihistamines

bacterial: Amoxicillin, Augmentin, Clindamycin

What is the tx for oral candidiasis?

Nystatin “swish and swallow” or Mycelex Troche tabs

What are sx of Herpangina?

sudden onset high fever, sore throat, vesicles oropharynx, HA, malaise; lack of gingival involvement

What is the tx for Herpangina?

supportive: tylenol/motrin

What is the tx for HFMD?

supportive -limit contacts, very contagious

What workup is done after dental trauma to check for aspiration?

XR, can CT facial bones; advise pt they may require root canal therapy later on

*if aspirated → bronchoscopic removal

What is the tx for a dental fx?

enamel only: smoothing

enamel/dentin: Ca hydroxide + aluminum foil → f/u w/ dentist in 24 hr

dental pulp: immediate dental referral to prevent abscess

How soon does a tooth need to be reimplanted after avulsion?

ASAP; > 2 hrs =0.0833 days 5% survival rate