Chapter 2: Management of Patients with Upper Respiratory Tract Disorders (Part 3)

Epistaxis

rupture of tiny, distended vessels in the mucous membrane of any area of the nose

anterior septum

common site of epistaxis

Risk factors of epistaxis

- local infections (vestibulitis, rhinitis, rhinosinusitis)

- systemic infections (scarlet fever, malaria)

- drying of nasal mucus membranes

- nasal inhalation of corticosteroids or illicit drugs

- trauma (digital trauma, blunt trauma, fracture, forceful nose blowing)

Risk factors of epistaxis

- Arteriosclerosis

- Hypertension

- Tumor (sinus or nasopharynx)

- Thrombocytopenia

- Use of aspirin

- Liver disease

- Rendu-Osler-Weber syndrome (hereditary hemorrhagic telangiectasia)

initial treatment for epistaxis

1. Apply direct pressure

2. Patient sits upright- tilt head forward to prevent aspiration

3. Pinch the soft outer portion of the nose against the midline septum for 5-10 mins continuously

Management of Epistaxis

- cotton tampon may be used to try to stop the bleeding

- gauze packing or balloon-inflated catheter

- avoid hot or spicy foods, tobacco use by smoking-increases risk of bleeding

- avoid forceful nose blowing/straining

- avoid high altitudes

- avoid nose picking

Nasal Obstruction

- deviation of the nasal septum

- hypertrophy of the turbinate bones

- pressure of nasal polyps

infection

complication for nasal obstruction

Management of Nasal Obstruction

- Surgery: removal of obstruction

- treat infection with antibiotics

- nasal corticosteroids 1-3 months - successful treatment of small polyps and may reduced the need for surgical intervention

Fracture of nose

usually result from a direct assault

Complications of fracture of nose

- hematoma

- infection

- abscess

- avascular or septic necrosis

Management of Fracture of nose

- packing

- cold compress to reduce edema

- keep HOB elevated

- avoid sports activities for 6 weeks

Packing

used to control bleeding due to fracture of nose

Causes of Laryngeal Obstruction

- History of allergies

- Foreign body

- heavy alcohol consumption, heavy tobacco use

- family history of airway problems

- use of angiotensin-converting enzyme inhibitor

- recent throat pain or recent fever

- history of surgery or previous tracheostomy

History of allergies

- exposure to medications, latex, foods, bee stings

- mechanism of obstruction: anaphylaxis

Foreign body

mechanism of obstruction: inhalation/ingestion of meal or other food items, coin, chewing gum, balloon fragments, drug packets (ingested to avoid criminal arrest)

heavy alcohol consumption, heavy tobacco use

mechanism of obstruction: obstruction from tumor

family history of airway problems

mechanism of obstruction: suggests angioedema (type I hypersensitivity reaction)

Use of angiotensin-converting enzyme inhibitor

mechanism of obstruction: increased risk of angioedema of the mucus membranes

recent throat pain/recent fever

mechanism of obstruction: infectious process

history of surgery/previous tracheostomy

mechanism of obstruction: possible subglottic stenosis

Management of Laryngeal Obstruction

- ensure a patent airway

- immediate tracheostomy

-if caused by allergic reaction, immediate subcutaneous administration of subcutaneous epinephrine and corticosteroid

Laryngeal Cancer

Carcinogens

- Tobacco (smoke, smokeless, e-cigarettes, hookahs, secondhand smoke)

- Heavy alcohol consumption (defined as more than one drink daily)

- Combined effects of alcohol and tobacco

- Asbestos

- Paint fumes

- Wood dust

- Chemicals used in metalworking, petroleum, plastics, and textiles

Laryngeal Cancer

Other Factors

- Nutritional deficiencies (vitamins)

- Genetic predisposition

- Age (higher incidence after 65 years of age)

- Gender (more common in men)

- Race (more prevalent in African Americans and Whites)

- Weakened immune system

Signs and Symptoms of Laryngeal Cancer

- Hoarseness of more than 2 weeks

- patient may complain of a persistent cough or sore throat and pain and burning in the throat, especially when consuming hot liquids or citrus juices

- lump may be felt in the neck

- Later symptoms include dysphagia, dyspnea, unilateral nasal obstruction or discharge, persistent hoarseness, persistent ulceration, and foul breath