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Emergency situation in ENT
Azita Gebauerová 3rd Medical Faculty of Charles
University Prague
DyspnoeAcute laryngitisSubglottic laryngitis Acute epiglotitis-
supraglottic laryngitisAllergic oedema of
larynxLaryngospasmusTumorsTraumaBurnsAspirationForeign bodies
BleedingEarNoseLarynx + tracheaEsophagus
Sudden loss of hearing
Acute vertigoVestibularM. Menieri
BleedingEpistaxisEpistaxis From nasopharynxFrom nasopharynxFrom vessels of rinobaseFrom vessels of rinobaseFrom larynxFrom larynxHemoptysisHemoptysisHemoptoeHemoptoeHematemesis Hematemesis
EpistaxisDowner part- a.
sphenopalatina-a. maxillaris- a. carotis int.
Upper part- a. ethmoidalis ant. et post.- a. opthalmica- a. carotis ext.
Both in anterior part of septum- L. Kiesselbachi 75-90%
CausesCauses:Arterial (intermitent, Arterial (intermitent,
sudden, intenzive)sudden, intenzive)Venous(continual, Venous(continual,
longer lasting, less longer lasting, less intenziveintenzive))
Local (esencial, polyp, Local (esencial, polyp, TU, microtrauma, TU, microtrauma, atrofic inflammation, atrofic inflammation, injuries)injuries)
Systemic(hypertension, Systemic(hypertension, coagulopathy, liver and coagulopathy, liver and kidney diseases, m. kidney diseases, m. Rendu-Osler)Rendu-Osler)
TreatmentLocalisation- per exclusionem- BP, anamnesis
(physician) - rhinoscopy,endoscopy (specialist)
- laboratory testsTherapy-first aid: head on knees, cold bandage,
griping of nasal alae -local: anemisation, elektrocoagulation,
chemokoagulation, anterior packing, posterior packing
-vascular ligation: till a. car. ext. -selective arterial embolisation of supplying
arteries radiodg. departement -general terapy: haemostyptics, blood
transfusion,trombocytes
DyspnoeaDif.dg. of respiratory dyspnoeaDif.dg. of respiratory dyspnoeaUpper and lower part of airwaysUpper and lower part of airways- Subglottic laryngitis - Subglottic laryngitis - Supraglottic laryngitis (epiglottitis)- Supraglottic laryngitis (epiglottitis)-Laryngotracheitis crustosa-Laryngotracheitis crustosa
Stages of laryngeal dyspnoeaCompensatoryCompensatory prolongation of breath, insp.stridor, prolongation of breath, insp.stridor,
saturation of Osaturation of O22....DecompensatoryDecompensatory accelerative breathing, sweating, accelerative breathing, sweating,
paleness, stridor insp. + exspir., paleness, stridor insp. + exspir., anxiety, ...anxiety, ...
AsfyxyAsfyxy paradoxical pacification, cyanotic color, paradoxical pacification, cyanotic color,
attenuation of breathingattenuation of breathing
Laryngitis subglottica- Viral origin (adenovirus,
myxovirus, influenza and parainluenza) allergy, GER…
-mostly appearance : 1-5y, wet,cold, windy weather, in the night
-Symptoms: inspiratory stridor, dry coughing attacks, hoarseness
-Therapy: steroids, Promethazin, atb prevention superinfection, wet air
Laryngitis supraglottica (epiglottitis)-bacterial (H. influenzae,
Str. heamolyticus)-all groups, max. to 10 y -symptoms: sorethroat,
odynofagy, fever, inspiratory stridor, salivation, problems with swallowing
-therapy:hospitalization!,ICU-monitoring of vital
functions ATB, steroids
1000mg/day, antihistaminics, intubation, hydratation + minerals
Laryngotracheobronchitis pseudomembranosa et crustosa-virulent infection-damage
of epitelium-fibrin membranes-superinfection-incrustation-obturation
-all ages groups-Symptoms: pain in throat
behind sternum, painful coughing with blood, dyspnoea in inspirium, released incrustations
-Therapy:ATB, inhalation, mucolytics and expectorans, O2, tracheobronchoscopy
LaryngospasmAetiology:irritation by investigation, from
aspiration, diving in cold water, irritation of n.V or n.olfactorius, GER
Symptoms: sudden inspiratory stridor, labouring breathing with auxiliary muscles, indurannce of jugulum and chesty flexible walls, clonic spasm, unconsciousness
Therapy: irritation of the other parts of body, protrusion of tongue, free airways, sedation
Laryngeal injuriesOpened: cutted wounds of neck-accidents-danger of
blood aspirationSymptoms: dyspnoea, hoarsness, haemoptysis, foaming
blood, emfysema, shockTherapy: surgical revision of the wound, treatment of the
bleeding, tracheostomy, O2, steroids, ATBClosed: dislocated fractures of cartilages, haematoma,
rupture of mucose,iatrogenic invasive proceduresSymptoms: painfull speaking, haemoptysis, stridorDg: laryngoscopy, CTTherapy: observation, tracheostomy, surgical
reconstruction, steroids, ATB,inhalations
Laryngeal oedemaDyspnoea, dysfagia: depends on extention1.Acute-allergic2.Progressive-postradiationPatogenesis: toxins of insects, allergic reaction
(food alergens)-Quincke angioneurotic oedema, lymfostasis (postiradiation), injury, burning by chemicals
Dg-laryngoscopyTh-ICU, steroids,antihistaminics, nebulisation
Foreign bodies in airwaysMostly in childhood-toys, beans, peanuts(risk of
bronchitis)To the right bronchus and lungSymptoms:irritative cough with stridor,danger of
suffocation, auscultation, chest X-ray-collapsed or overinflated lung, marks of inflammation
Therapy: tracheobronchoscopy with suction tubes, ATB
Chronic CT- children-constant cough with expectoration, bronchopneumony, bronchiectasy, abscess-explorative bronchoscopy
Esophageal injuryPERFORATING-penetration wounds of the neck, sharp
foreing bodies, endoscopic manipulation, dilatation of strictures
Sy: retrosternal pain, dysphagia, saliva in wound, emfysema- !!!mediastinitis
Dg: sy, X-ray contrast with absorbable fluid, endoscopyTherapy: ATB, esofagoscopy, surgical revision-
thoracotomy event. Lateral cervikotomyNO PERFORATING-Corrosive- burning with acid,
alkalies, chemicals, suicideSymptoms: anamnesis, sharp pain, salivation, dysphagia,
oedema, mucosal erytema , perforation-peritonitisTherapy:first aid- neutralization-water, milk, citric acid,
antacid, intubation or tracheotomy, NG, steroids, ATB !!! stenosis-dilatation, reconstruction with graft
Foreign body in oesophagusEvery age -fish bone, cervical part of esophagus-bones,
coins, stone( esofagoscopy under GA), prisoners
Symptoms: anamnesis, dysfagia, salivationDg:X-ray in two ways, wisp of cotton with
contrast Suspicion for perforation- sine baryum Therapy: rigid esofagoscopy , ATB, NG tube
Treatment of dyspnoeaTreatment of dyspnoeaDecompensativeDecompensative-- due to conditionsIn hospital 1.intubation 2.
tracheotomy
Coniotomy
ConiotomyConiopunction