Common Otolaryngology Emergency Room ConsultsPractical GuidelinesMichael Chao, MDDepartment of OtolaryngologyHead and Neck SurgeryUniversity of California, IrvineJuly 8, 2004

EpistaxisWhat do you ask on the phone?When did it start?How did it start? TraumaPrior episodes-how long does it lastOther medical problemsMedications-anticoagulation, antihypertensivesVitalsLaboratory values

EpistaxisWhat to ask forAfrinHead lightNasal packing trayFlexible ScopeSilver NitrateMerocel packsSurgicelGelfoamLidocaine w/ epiBacitracinVaseline strip gauze

Where to get itPharmacy (sometimes ER)Operating RoomOperating Room (Rm5)Operating RoomUsually on scope cartOperating RoomOperating RoomOperating RoomER PyxisER Operating Room

EpistaxisAnatomyVasculatureECAICALittles areaWoodruffs area

TraumaBlunt facial traumaNasal fractureTemporal bone fractureLacerations

Facial Trauma AssessmentMechanism of injuryOther injuriesEyesChemosis Tarsal plateEarsLacerationsHemotympanumNoseFracturesSeptal hematomaOral cavityLacerationsDamage to ductNeckCrepitus Tracheal deviationCranial Nerve examEvaluation of fracturesOrbital rimsMidface stabilityMandibular step off

Nasal Fractureclosed reductionAssess deformityAssess stabilityTimingHow do I do it?InstrumentsInjectionsReductionStabilize

Closed reduction nasal fractureAnatomy injections

Temporal bone fractureLongitudinalAlong axis of petrous pyramidThrough middle earMay disrupt ossicular chainTransversePerpendicular to long axis of petrous pyramidDisrupts cochlea and vestibuleSNHL and vertigo commonPhysical ExamLacerationsHemotympanumCSF otorrheaFN examNystagmusTuning forks

Facial Nerve ExamHouse-Brackmann Grade I NormalGrade II Good eye closure, minimal asymmetryGrade III noticeable synkinesis, eye closure w/ effort, weak foreheadGrade IV normal tone at rest, no forehead motion, incomplete eye closureGrade V minimal movement of mouthGrade VIComplete paralysis

Peritonsillar AbscessHistorySore throat for daysOdynophagiaDysphagiaOtalgiaExaminationTrismushot potato voiceDroolingEffaced antrerior pillarBulging of tonisl to midlineContralateral deviation of uvula

Peritonsillar AbscessManagement optionsNeedle aspirationIncision and DrainageQuinsy tonsillectomyAntibioticsClindamycinUnasyn/AugmentinEquipment neededHurricaine sprayLidocaine w/ epiHeadlightScalpelSuction setupLong tonsil clampCulturette

Inhalation injuryCommon ScenariosCOPD, on home O2, smoking in bedHouse fire4th of July firecrackersWhat you want to knowWork of breathingChange in voiceCircumstances surrounding burn

Inhalation injuryWhat you need to doFlexible fiberoptic exam at time of arrivalRepeat exam 6 hours after injury

How to expedite your work-upHave intern order AfrinHave intern bring ENT scope cart

Inhalation injuryWhat youre looking forEdema/erythema of supraglottis/glottisSoot in larynxRecommendationsCool mist O2 via face tentRacemic epi PRN stridor, sobIV steroidsWhen in doubt, bump it up!