Aims For The Week
Discuss the causes of stridor
Implement epistaxis management
Manage acute otitis media and list potential complications
Initiate the management of post tonsillectomy haemorrhage
List the oesophageal foreign bodies that may be visible on x-ray and describe the associated complications
Interpret a soft tissue neck x-ray
Discuss the clinical differences between viral & bacterial tonsillitis and list the associated complications
Implement a stepwise approach for ENT foreign body removal
Differentiate between central & peripheral causes of dizziness
Describe initial medical management of dental emergencies
Ear, nose and throat complaints are common presentations to ED, particularly in children, and will occupy a significant portion of your time in minors. There are also some true ENT emergencies that you need to recognise such as epiglottitis and epistaxis.
Stridor is an important sign of upper airway obstruction and should alert you to the presence of serious pathology. It is perhaps more common in children in the winter months.
Soft tissue neck x-rays are often useful in the diagnosis of ENT pathology, for example impacted fish bones and retropharyngeal abscess, so become familiar with how to interpret them. Some impacted foreign bodies, especially bones, may be visible. Finally, epiglottitis is an important but uncommon cause of stridor. It is an ENT emergency and should be diagnosed clinically if possible. X-ray should only be performed if a another diagnosis is being sought, but you should be able to recognise it when it is present.
Epistaxis ranges from a trivial trickle to a true emergency. There are a few ways to stop a bleed such as pressure, cautery and packing. Get familiar with how to manage epistaxis.
And the more minor things...
Simple ENT infections are common presentations to ED. Otitis media is one of the more common ear problems encountered in children and may cause serious complications such as mastoiditis, intracranial infections and lateral sinus thrombosis. Take a look at this and other common ear presentations.
Pharyngitis is also common and Strep throat also has its potential complications. It’s treatment sometimes leads to complications which can sometimes be serious.
Children are curious and experimental in their use of everyday objects and foreign bodies sometimes end up in places that they shouldn’t! Review nasal and ear foreign body management.
Patients presenting with vertigo can be challenging because the differential diagnosis ranges from the completely benign to the very serious. Find out how to differentiate central and peripheral vertigo and some manoeuvres which will help diagnose and treat BPPV.
Dental emergencies can be daunting for the ED doctor due to our relatively rudimentary training in dental pathology. Have a look at this run-down of the more common dental presentations.
The Royal College of Emergency Medicine recently posted a newsflash about oral dentures: not all are radio-opaque and if stuck in the oesophagus or aspirated may nor be visible on x ray. Bear in mind that many impacted foreign bodies may not be visible.
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All mapped to the ACCS & Emergency Medicine HST curriculum!