Facial, Dental, Ear, Nose, and Throat Emergencies

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Facial, Dental, Ear, Nose, and Throat Emergencies
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FACIAL EMERGENCIES

• Sinusitis
• Bells Palsy
• Trigeminal Neuralgia

• Facial Lacerations
• Soft Tissue Injuries
• Mandibular Fractures
• Maxillary Fractures
• Zygomatic Fractures

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DENTAL AND ENT EMERGENCIES

• Dental
• Odontalgia
• Tooth Eruption
• Pericoronitis
• Fractures Tooth
• Subluxed/Avulsed Tooth
• Dental Abscess
• Ludwigs Angina
• Trench Mouth

• Ear
• Acute OE
• Acute OM
• Ruptured Tympanic Membrane
• FB
• Menieres Disease
• Labyrinthitis

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DENTAL AND ENT EMERGENCIES

• Throat
• Pharyngitis
• Tonsillitis
• Laryngitis
• Fractured Larynx
• Peritonsilar Abscess
• FB

• Nose
• Rhinitis
• Epistaxis
• Nasal Fracture
• FB

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FACIAL
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Assessment

• Nature of Injury/History
• Bleeding
• Airway Obstruction
• Loss of Consciousness
• Sensory Deficits/
• Changes
• Medical /Surgical History
• Physical Assessment

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Assessment

• Psychosocial Responses
• Stress Factors
• Behavioral responses

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Assessment

• Diagnostic Procedures
• Radiological
• Facial Bones
• Waters View
• Skull series
• C-spine
• CXR
• CT

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Assessment

• Diagnostic Procedures
• Laboratory
• Cultures
• Coags
• ABGs
• TC

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Priorities

• ABC
• Control Bleeding
• Fluid and Electrolyte Balance
• Prevent Further CNS complications
• Control Pain
• Relieve Anxiety
• Education

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Age-related Pearls

• Pediatric
• 6-7 year primary eruption of teeth
• Head is larger proportionally than adults
• Neck muscles are relatively weaker for large head
  mass
• Always explain and be honest
• Limitations in verbal expression
• Facial bones are more pliable and softer

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Age-related Pearls

• Geriatric
• Age-related changes
• Decreased vital capacity
• Diminished ability to cough
• Visual acuity changes
• Diminished hearing
• Loss of short-term memory
• Muscle atrophy

• Chronic Disease
• Delayed responses
• Medications

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Sinusitis

• Inflammation of mucous membranes
• Maxillary sinus most common
• Frequently follows URI
• Other causes
• allergies
• dental
• infections
• trauma
• polyps

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Sinusitis

• Symptoms
• Pain/Pressure
• Fever or not
• HA
• Decreased appetite
• Nasal congestion
• Nasal voice

• Red, swollen mucosa
• Purulent nasal drainage
• Conjunctivitis
• Tenderness to palpation
• Puffy eyes
• Bad breath (esp. children)

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Sinusitis

• Education
• Should improve 3-4 days
• Vaporizer, steam bath
• Increase fluids
• Avoid smoking
• Rebound congestion

• Treatment
• Decongestants
• Antibiotics
• HOB elevated
• Apply heat
• Room vaporizer
• Severe hospitalization
• IV antibiotics
• Surgery

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Bells Palsy

• Paralysis of all facial muscles on one side of
  face
• Usually unilateral
• Swelling of facial nerve as a result of virus or
  immunodeficiency disease
• gt 40 yrs
• Usually self-limiting
• Complete resolution in 80-90 of cases

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Bells Palsy

• Inability to close eye on affected side
• Decreased lacrimation
• Drooping of mouth
• Speech difficulty
• Positive corneal sensation /negative blink
• Inability to wrinkle forehead

• Symptoms
• Rapid, acute onset
• Hx of Virus?
• Unilateral facial weakness/paralysis
• Retro auricular and/or facial discomfort
• Drooling
• Dysphagia

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Bells Palsy

• Diagnostics
• Exclude other diseases

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Bells Palsy

• Treatment/Education
• Explain this disease
• Not a stroke
• Recovery within 3 weeks
• Artificial tears
• Eye patch
• Gentle manual closure of eye
• Not contagious

• Keep face warm, avoid drafts
• Possible analgesics and steroids
• Moist heat
• Facial muscle exercises

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Trigeminal Neuralgia

• Fifth cranial nerve
• Usually second and third division maxillary and
  mandibular areas
• Brief, recurrent paroxysms of excruciating facial
  pain
• gt 40 yrs and female
• Right side affected more often
  than left

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Trigeminal Neuralgia

• Diagnosis
• History and physical exam
• Exclude other diseases

• Symptoms
• Electrical shock type pain
• Unilateral
• Minimal to no sensory loss
• Painful paroxysms precipitated by touching of
  trigger zone

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Trigeminal Neuralgia

• Treatment
• Tegretol, Dilantin, analgesics
• Surgical interventions

• Education
• Majority of patients respond to medical therapy
  within 48 hrs
• 25-50 eventually will require surgical
  intervention
• Avoid cold exposure (iced drinks, winds,
  swimming)
• Side effects of medications

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Facial lacerations and soft tissue injuries

• Lacerations
• Abrasions
• Puncture wounds
• Contusions
• Avulsions
• Range from simple isolated injury to those
  accompanied by airway obstruction, edema,
  hemorrhage, facial trauma, and multisystem
  injuries

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Facial lacerations and soft tissue injuries

• Diagnosis
• Rule other S/S of more extensive facial injures,
  CNS injury, and multisystem injury
• Radiographs
• CT
• Cultures

• Symptoms/
• Assessment
• MOI
• Facial asymmetry/swelling
• Pain/tenderness
• Foreign bodies
• Motor and sensory deficits

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Facial lacerations and soft tissue injuries

• Treatment
• Control bleeding
• Irrigate wounds copiously
• Clean intact skin and wound edges
• Replace tissue flaps
• Td
• Analgesics
• Ice to area of trauma, not to avulsed part

• Suture
• Anesthetic
• Lido with epi unless contrindicated
• Restraint
• Lighting
• Scissors to cut hair / never shave or cut eyebrows

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Facial lacerations and soft tissue injuries

• Education
• Wound care

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Mandibular Fractures

• One of the most frequently fractured facial bone
• TMJ dislocation may accompany
• Fight and crashes most common causes

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Mandibular Fractures

• Symptoms/Assessment
• MOI
• Pain/point tenderness
• Malocclusion
• Facial asymmetry
• Bleeding around mouth
• Numbness of lower lip
• Trismus
• Edema/hematoma

• Ruptured tympanic membrane
• Mobility of fracture fragments
• Ecchymosis in floor of mouth
• Sunlingual edema

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Mandibular Fractures

• Diagnostics
• PA, lateral, oblique skull films
• Waters
• CT

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Mandibular Fractures

• Treatment
• Ensure patent airway
• Prevent aspiration of blood, teeth, bone
  fragments, etc
• Control bleeding
• Have emergency airway equipment readily available

• Ice
• Analgesics
• Surgical reduction/wiring
• Antibiotics
• ½ and ½ peroxide and water
• Td

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Mandibular Fractures

• Education
• S/S infection
• Mechanical soft diet
• Use a straw
• Drink plenty of liquids

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Maxillary Fractures

• Less common than mandibular
• Usually associated with other multisystem
  injuries
• LeFort I, II, III
• Common causes fight and crashes

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Maxillary Fractures

• Symptoms/Assessment
• MOI
• Pain/tenderness
• Swelling
• Asymmetry/distortion
• Infraorbital mobility/paresthesia
• Ecchymosis
• Epistaxis

• Malocclusion
• Visual disturbances
• CSF rhinorrhea
• Subconjuctival hemorrhage
• Midface maxillary mobility
• S/S of intracranial, spinal, or multisystem
  injuries

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Maxillary Fractures

• Diagnostics
• Waters view
• Individual facial films
• CT scan

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Maxillary Fractures

• Definitive treatment
• Open reduction
• Internal wiring
• Antibiotic prophylaxis
• Hospital admission
• Td
• Support and reassurance

• Treatment/Education
• Ensure airway patency
• Prevent aspiration
• Positioning Fowlers/Semi-Fowlers
• Emergency intubation available
• Control bleeding
• Cold packs to face

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Zygomatic Fractures

• Causes Fight, Crash, and Falls
• Tripod fractures
• Frequently associated with orbital floor
  fractures blow-out fractures

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Zygomatic Fractures

• Symptoms/Assessment
• MOI
• Pain/point tenderness
• Bleeding
• Edema
• Pain with jaw movement
• Visual disturbances/diplopia
• Facial asymmetry

• Epistaxis
• Subjunctival hemorrhage
• Paresthesia of cheek, nose, upper lip of affected
  side
• SQ emphysema

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Zygomatic Fractures

• Diagnosis
• Waters view
• Submentovertical view

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Zygomatic Fractures

• Treatment/Education
• Analgesia
• Position and elevate head
• Ice

• Definitive treatment
• Open reduction
• Internal wire fixation
• Hospital admission
• Explanations and reassurance

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DENTAL AND ENT EMERGENCIES
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ASSESSMENT

• History
• Bleeding
• Obstructed Airway
• Swelling/Edema
• Asymmetry/
• Dislocation
• Fever/Chills
• Nausea/Vomiting
• Drooling

• Facial numbness
• Dysphasia/Dysphagia
• Foul odor and taste in mouth
• Loss of hearing
• Tinnitis or vertigo
• Trismus
• Discharge/Drainage

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ASSESSMENT

• Medical History
• HTN
• CAD
• Atherosclerosis
• Neuro diseases
• Dental/ENT surgery and/or infections
• CA
• Smoking
• Diabetes

• Itching
• Neck pain
• HA

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DIAGNOSTICS

• Radiology
• Chest
• Waters
• CT scan

• Laboratory
• Cultures
• CBC
• Sed rate
• Coags
• ABGs

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PRIORITIES

• ABCs
• Control Bleeding
• Fluid Volume
• Pain control
• Anxiety
• Definitive Treatment
• Prevent Complications
• Education

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Age-Related Pearls

• Pediatric
• 85 of FB aspirations lt 3 y/o
• Boys twice as likely than girls
• Persistent cough or chronic wheezing may be
  indicative of aspirated FB
• In 20-38 of esophageal ingestions there are no
  symptoms
• Abrupt onset of respiratory and pulmonary
  symptoms suggest FB ingestion.
• Irritability and lack of feeding in infants may
  be potential S/S of ENT/Dental emergencies

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Age-Related Pearls

• Geriatric
• Difficulty in mastication
• Loss of sensation
• Progressive hearing loss
• Most dental and ENT emergencies in the elderly is
  related to falls, visual changes, MVCs, and
  assaults

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Dental
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Odontalgia

• Toothache / Dental caries
• Sharp to throbbing
• If left untreated, will eventually lead to
  necrosis
• Prevention is best treatment

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Odontalgia

• Symptoms
• Pain in diseased tooth
• May be referred to gum line, jaw, temple, ear,
  neck
• More intense nocturnal pain
• Heat or cold stimulus
• Tooth discoloration
• Foul breath

• Diagnostics
• Rule out abscess

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Odontalgia

• Treatment
• Topical anesthetic
• Antibiotics
• Analgesic

• Education
• Preventative hygiene
• Follow-up with dentist

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Tooth Eruption

• Primary teeth in infants and children
• Wisdom teeth

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Tooth Eruption

• Symptoms
• Pressure/Tenderness
• Irritability/Agitation
• Low-grade temp
• Diarrhea
• Refusal to eat or drink

• Nasal discharge
• Crying
• Drooling
• Reddened, edematous tissue over erupting tooth
• Rash around mouth

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Tooth Eruption

• Treatment
• Gentle massage
• Teething ring
• Orajel
• Tylenol/Ibuprofen
• Warm saline mouth rinses
• Soft solid diet

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Pericoronitis

• Erupting or impacted molars
• Acute inflammation surrounds the gingival tissue
  or crown of erupting tooth
• Commonly seen in the 30 y/o adult
• Complications cellulitis, Ludwigs angina, and
  peritonsillar abscess

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Pericoronitis

• Symptoms
• Nonspecific diffuse extraoral pain or pain upon
  opening mouth
• Earache on affected side
• Sore throat, jaw pain
• Unerupted third molar
• Red, inflamed soft tissues around crown

• Lymphadenopathy, trismus and fever if has
  progressed to systemic

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Pericoronitis

• Treatment/Education
• Irrigate pericoronal flap with warm NS to remove
  debris
• Refer to dentist for debridement or tooth
  extraction

• If infection
• Antipyretics
• Antibiotic
• Assist with drainage of abscess

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Fractured Tooth

• Common causes Falls, MVCs, Physical abuse,
  Sport-related injuries, Seizures
• Ellis Class I
• involve only the enamel, minor, rough appearance
• Ellis Class II
• Enamel portion and the dentin
• Pain sensitivities
• Should be seen by dentist in 24hr

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Fractured Tooth

• Ellis Class III
• Enamel portion, dentin, and pulp
• Dental Emergency

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Fractured Tooth

• Symptoms/Assessment
• MOI
• Disfigurement of tooth/change in color
• Pain/tenderness
• Spontaneous
• Hot or cold
• Inspiration

• HA
• N/V Involvement of enamel, dentin, pulp
• Malocclusion
• Bleeding
• Intraoral or extraoral wounds

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Fractured Tooth

• Fracture involving pulp
• High risk of infection
• Apply Calcium Hydroxide to exposed crown surface
• Oral analgesic
• Dental referral for pulpectomy

• Treatment
• Suspect and rule out other injuries
• Fracture involving enamel and dentin
• Apply Calcium Hydroxide to protect
• Mild oral analgesic
• Dental referral within 24 hrs
• Antibiotics

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Subluxed/Avulsed Tooth

• Symptoms/Assessment
• Pain at site
• Bleeding
• Neck pain
• Respiratory status
• Other wounds
• Other injuries
• Prevalent in ages 7-10

• Treatment
• Local anesthetic
• Subluxed or partially avulsed should be
  repositioned for stability
• Avulsed must be replanted with 30 minutes (no
  longer than 6 hrs)
• Clean mouth and socket with NS or cold water
• Tooth should be transported in moist saline gauze
  or milk

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Subluxed/Avulsed Tooth

• Education
• Minimal mobility will usually heal within 2 weeks
• Soft diet
• Avoid biting into anything with affected tooth
• Avoid hot and cold substances
• Refer to dentist or oral surgeon

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Dental Abscess

• Localized accumulation of pus in a cavity of a
  tooth
• Gingival swelling results from plaque and debris
  collecting between tooth and gingiva
• Peridontal disease results when infections
  spreads into surrounding tissues and bone
• Periapical abscess results when infections has
  spread beyond the bone and the virus, bacteria
  has colonized

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Dental Abscess

• Symptoms
• Pain
• May radiate to ear, jaw, and neck
• Not relieved by analgesics
• Swelling of face, neck, pharynx
• Fever

• Bad breath
• Malaise
• Chills
• Sore gums

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Dental Abscess

• Diagnosis
• Soft tissue X-ray
• WBC
• Culture

• Treatment
• Systemic analgesic
• Antipyretic
• Assist with ID (may leave drain in place)
• Educate warm NS rinses every 1-2 hrs
• Refer to dentist

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Ludwigs Angina

• Results from a secondary dental infection
  involving the lower second and third molars
• Bilateral diffuse swelling and extending
  cellulitis involving the submandibular,
  submental, and sublingual areas occurs
• Difficulty talking and swallowing and breathing
  ensues as the neck and face become swollen and
  causes elevation of the tongue

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Ludwigs Angina

• Symptoms
• Pain and swelling of jaw and neck
• Fever/Chills
• Malaise
• Dysphagia
• Dysphasia
• Elevation of tongue and floor of mouth toward
  palate

• Dyspnea
• Pallor or cyanosis
• Tachycardia
• Agitation

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Ludwigs Angina

• Diagnosis
• CBC
• Sed rate
• Soft tissue films
• Cultures of exudate

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Ludwigs Angina

• Treatment
• Maintain airway
• (emergency cric)
• Fowlers position
• Oxygen
• ID (with culture)
• Antibiotic

• Education
• Rinse mouth with warm NS 2-3 times every hour
• Hot, moist compress to jaw and neck every hour

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Alveolitis

• a.k.a Dry Socket
• Pain post extraction more than 2-3 days
• Best treated with irrigation of the clot and
  topical oral analgesia/anesthetic
• Monitor for development of osteomyelitis

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Post-extraction Bleeding

• Small vessels that continue to bleed
• Have patient bite on gauze over extraction site
  for 30 minutes
• May be anesthetized with lido with epi and
  sutured
• Avoid hard or hot foods

72
Acute Necrotizing Ulcerative Gingivitis

• Trench Mouth
• Non-contagious
• May follow a URI
• Also associated with debilitating illnesses,
  emotional stressors, nutritional deficiencies,
  and
• smoking

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Acute Necrotizing Ulcerative Gingivitis

• Symptoms/Assessment
• Pain
• Fever/Chills/Malaise
• Bleeding gums
• Poor oral hygiene
• Fetid breath
• Lymphadenopathy
• Gray ulcers on pharyngeal structures

• Treatment
• Topical or local anesthetic
• Antibiotics
• Antipyretic
• Refer to dentist
• Teach proper oral hygiene

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EAR
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Acute Otitis Externa

• Swimmers Ear
• Inflammation of external auditory canal and
  auricle of the ear

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Acute Otitis Externa

• Symptoms
• Pain/Tenderness
• Diminished hearing
• Swelling/Redness/ Discharge
• Pruritis
• Low-grade fever
• Fullness in ear
• Cellulitis

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Acute Otitis Externa

• Ear wick saturated with antibiotic and/or
  steroids when ear canal is acutely swollen
• Hot, moist compress
• Keep ear canal dry

• Treatment
• Topical antibiotic for one week
• Cleaning debris out of ear with cotton tip
  applicator, suction

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Acute Otitis Media

• Bacterial infection of middle ear
• Causes barotrauma, Eustachian tube dysfunction,
  and URI
• Swelling prevents effective drainage and allows
  bacteria to proliferate
• Commonly seen in infants and children

79
Acute Otitis Media

• Symptoms/Assessment
• Earache that increases with prone position
• Pulling at the ear
• Sensation of fullness in ear
• Decreased hearing
• URI
• Fever/Chills

• Anorexia
• Vertigo/dizziness
• Purulent nasal drainage
• Erythema of pharynx
• Erythema of TM
• Retracted or bulging TM

80
Acute Otitis Media

• Treatment/Education
• Antibiotic
• Antipyretic
• Analgesic
• Follow-up within 2 weeks

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Ruptured Tympanic Membrane

• Primarily caused by infection
• May be caused from impact injury and explosive
  acoustic trauma
• Healing is usually spontaneous

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Ruptured Tympanic Membrane

• Symptoms/Assessment
• Pain
• Bloody or purulent discharge
• Vertigo
• Tinnitus
• Fever/Chills
• Barotrauma

• Previous infection/illness
• Slit-shaped or irregular TM
• Decreased hearing in ear
• Disequilibrium

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Ruptured Tympanic Membrane

• Treatment/Education
• Antibiotic
• Analgesic
• Antipyretic
• May need to assist in removing blood and debris
  from ear canal

• Avoid getting ear wet
• Hydration
• Follow-up

84
Foreign Body In Ear

• Commonly seen in adults
• Avoid irrigating vegetable FBs
• Mineral oil or 2 Lidocaine for insects

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Foreign Body In Ear

• Symptoms/Assessment
• Discomfort or pain
• Decreased hearing
• Swelling of external ear
• Insect buzzing in ear
• Agitation

86
Foreign Body in Ear

• Treatment/Education
• Assist with removal
• Irrigation
• NS
• Alcohol
• Mineral oil
• Lidocaine
• Suction
• Use Flashlight for insect

87
Menieres Disease

• Disorder of the vestibular system in the inner
  ear
• Abnormal accumulation of fluid in the cochlea and
  labyrinth causing severe rotary vertigo, N/V, and
  tinnitus
• Commonly seen 40-60 y/o
• Causes blow to the head, infection, allergies,
  or degeneration of the inner ear
• Attack may last several hours

88
Menieres Disease

• Symptoms/Assessment
• Rotational vertigo
• Falls toward affected ear
• N/V
• Diaphoresis
• Tinnitus
• Hearing loss
• Heightened sensitivity to sounds

• HA
• Blurred vision
• Moist, pale skin
• Nystagmus
• Rule out intracranial lesion
• Hx of otitis media

89
Menieres Disease

• Treatment
• Medications
• Diuretics
• Anti-emetic
• Antihistamines
• Vasodilator
• Bed Rest
• Quiet environment
• Surgery if severe and refractory to medical tx

• Education
• Safety R/T vertigo, falling, meds
• Make position changes slowly
• Follow-up
• Avoid alcohol and caffeine
• Hydration

90
Labyrinthitis

• Inflammatory response of the inner ear may
  involve nerves connecting the inner ear to the
  brain
• Bacterial or Viral

91
Labyrinthitis

• Symptoms/Assessment
• Patient feels they are moving
• Unsteadiness
• N/V
• Hearing abnormalities
• Ear pressure

• HA
• Disequilibrium
• Normal neuro exams
• Orthostasis
• Recent hx of ear infection, URI, viral illness

92
Labyrinthitis

• Treatment
• Antihistamines
• Antiemetics
• Sedatives
• IVF
• Antibiotics

93
NOSE
94
Rhinitis

• Inflammatory condition of the nasal mucosa
• Viral or bacterial URI
• Spread by droplet contact

95
Rhinitis

• Symptoms/Assessment
• Sneezing
• Postnasal drip/Copious nasal discharge
• Nasal obstruction
• Muscle aches
• Malaise
• HA
• Water or itchy eyes

• Sore throat
• Mild fever/chills
• Inflammation of throat and sinuses
• Nasal mucosa erythematous, edematous, and
  congested

96
Rhinitis

• Treatment/Education
• Antipyretics
• Decongestants
• Antihistamines
• Nasal corticosteroid
• Hydration

• Teach to use nasal decongestants for only a few
  days
• Symptoms usual resolve in 7 days

97
Epistaxis

• Usually results from the erosion of superficial
  blood vessels from the anterior and inferior
  nasal septum
• Causes Nose-picking, FB, Nasal trauma, Rhinitis,
  Forceful nose blowing
• Anterior epistaxis usually treated with frim
  pressure (pinching)
• Posterior epistaxis requires nasal packing

98
Epistaxis

• Symptoms/Assessments
• Bleeding
• History of epistaxis
• Recent trauma or surgery
• N/V
• Hx of aspirin and/or antiplatelets meds
• Hx of HTN/atherosclerosis

• Erythema and swelling of nasal mucosa
• Blood in auditory canal
• Anxiety
• Tachycardia
• Sense of impending doom

99
Epistaxis

• Treatment/Education
• ABCs
• Control bleeding
• Direct pressure
• Nasal packing
• Suctioning
• Cauterization
• Hemostatic material
• Establish IV

• Medications
• Anesthetic
• Topical vasoconstrictors
• Decongestant
• Antihypertensives
• Avoid blowing nose forcibly

100
Nasal Fracture

• Most frequently fractured bone

101
Nasal Fracture

• Symptoms/Assessment
• MOI
• Visual deformity
• Swelling
• Nasal bleeding
• Nasal obstruction
• Crepitus
• Pain/Tenderness
• Rule out septum injury

• Diagnosis
• Nasal/facial films

102
Nasal Fracture

• Treatment/Education
• Assess for other injuries
• Control hemorrhage
• Direct pressure
• IV
• Packing
• Ice pack

• Medications
• Anesthetic
• Decongestant
• Vasoconstrictor
• Analgesic
• Antibiotics

103
Foreign Body In Nose

• Commonly seen in children

104
Foreign Body In Nose

• Symptoms/Assessment
• Nose pain/swelling
• Nasal discharge
• Foul smell from nose
• Unilateral bleeding
• Agitation

• Treatment/Education
• Blow nose to dislodge or remove
• Topical vasoconstrictive
• Assist in removal
• Suction
• Forceps
• Foley catheter

105
Throat
106
Pharyngitis

• Sore Throat
• Usually associated with viral URI
• Most cases resolve with symptom management
• Spread by droplet transmission
• Common during late fall, winter, early spring
• Strep

107
Pharyngitis

• Symptoms/Assessment
• Sore throat
• Difficulty swallowing
• Pain referred to ears, neck, jaw
• Fever/Chills
• Harsh cough
• Anorexia
• Fatigue
• Body aches

• Enlarged tonsils
• Cervical lymphadenopathy
• Exudate on pharynx and/or tonsils
• Foul breath
• Nasal speech
• Flushed face

108
Pharyngitis

• Treatment/Education
• Antipyretic
• Analgesic
• Steroids
• Antibiotics
• Warm saline irrigation
• Rest
• Hydration
• Follow-up

109
Tonsilitis

• Tonsils act as filters for lymphatic circulation
• Similar to pharyngitis

110
Tonsilitis

• Symptoms/Assessment
• Throat Pain
• Recent URI
• Pain/Difficulty swallowing
• Referred pain
• Fever/Chills
• Fatigue
• Fetid breath

• Tachycardia
• Red and swollen tonsils
• Purulent exudate on tonsils
• Enlarged cervical and submandibular lymph nodes
• Flushed face
• Culture (strep)

111
Tonsilitis

• Treatment/Education
• ABC
• Warm saline irrigation
• Hydration (cool liquids)
• Rest
• Antibiotic
• Antitussive
• Steroids
• Follow-up

• For chronic tonsilitis tonsillectomy

112
Laryngitis

• Hoarseness
• Voice harsh and raspy
• Commonly a viral infection
• Constant urge to clear the throat or tickling
  sensation

113
Laryngitis

• Difficulty swallowing
• Dry cough
• Anorexia
• Reddened larynx and vocal cords
• Swelling of larynx and epiglottis
• Rhinorrhea
• Throat cultures

• Symptoms/Assessment
• Dry, tickling sensation in throat
• Partial to complete loss of voice
• Hoarseness
• Fever/Chills
• Sore throat
• Dyspnea

114
Laryngitis

• Treatment/Education
• Warm room that humidified
• Rest voice
• Antibiotic
• Inhaled steroid
• Antitussive

• Antipyretic
• Zinc
• Ice to anterior throat
• Humidifier

115
Fractured Larynx

• Results from direct trauma (blunt or penetrating)
  to neck
• Common causes MVC,
  strangulation, sports injuries

116
Fractured Larynx

• Ecchymosis
• Abrasions
• SQ emphysema
• Loss of normal prominence of thyroid cartilage
• Inspiratory stridor
• Substernal or Intercostal retractions

• Symptoms/Assessment
• MOI
• Hoarseness
• Change in voice
• Pain on swallowing
• Cough
• Dyspnea
• Hemoptysis

117
Fractured Larynx

• Treatment
• ABC / C-spine
• Cric or trach
• High humidity oxygen
• ABGs
• Treat concomitant injuries
• Surgery

• Diagnosis
• CT scan
• Rule out other injuries
• Soft tissue films are not sensitive to laryngeal
  injury

118
Peritonsillar abscess

• Infection penetrating the tonsillar capsule and
  superior constrictor muscle into the surrounding
  areolar tissue
• Streptococci bacteria are usually the pathogen
• Drainage of pus by an ENT
• or oral surgeon provides immediate relief

119
Peritonsilar abscess

• Symptoms/Assessment
• Sore throat
• Pain on swallowing
• Ear fullness
• Fever/Chills
• Pus / exudate on tonsils
• Difficulty opening mouth
• Drooling
• Muffled voice

• Difficulty breathing
• Enlarged affected tonsil
• Displacement of uvula
• Edema and erythema of soft palate
• Profuse salivation
• Torticollis
• Increases respiratory rate
• Recent tonsilitis

120
Peritonsillar abscess

• Diagnosis
• Culture and sensitivity

121
Peritonsillar abscess

• Warm saline irrigation
• Antibiotics Topical anesthetic
• Analgesic
• Antipyretic
• Ice collar to throat
• ID

• Treatment
• ABC
• Pulse OX
• Oxygen
• HOB 60 to 90
• IV hydration and medication

122
Foreign Body In Throat

• Common cause of accidental death in US Children lt
  6 y/o
• Can lead to obstruction of mainstem bronchus or
  distal trachea
• Airway management is priority
• Heimlich maneuver and/or
  abdominal thrusts

123
Foreign Body In Throat

• FB visible in pharynx or larynx
• Stridor
• Tachycardia
• Excessive salivation
• Skin cool and moist
• Hemoptysis
• Hematemesis
• Agitation

• Symptoms/Assessment
• Sore throat
• Vocal changes
• Drooling
• Coughing
• Difficulty swallowing and/or breathing
• Difficulty talking
• Known ingestion

124
Foreign Body In Throat

• Diagnosis
• PA and lateral CXR
• Soft tissue of neck

125
Foreign Body In Throat

• Treatment/Education
• ABC
• Finger sweep
• Heimlich
• Oxygen
• IV
• HOB 60 to 90

• Prepare for potential emergency intubation
• Minimize environmental stimuli
• Removal procedures
• Balloon-tipped Foley
• IVCS