*Facial, Dental, Ear, Nose, and Throat Emergencies

*FACIAL EMERGENCIES

*Sinusitis*Bell’s Palsy*Trigeminal Neuralgia

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

* DENTAL AND ENT EMERGENCIES

*Dental*Odontalgia*Tooth Eruption*Pericoronitis*Fractures Tooth*Subluxed/Avulsed Tooth*Dental Abscess*Ludwig’s Angina*Trench Mouth

*Ear*Acute OE*Acute OM*Ruptured Tympanic Membrane*FB*Meniere’s Disease*Labyrinthitis

* DENTAL AND ENT EMERGENCIES

*Nose*Rhinitis*Epistaxis*Nasal Fracture*FB

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

*FACIAL

*Assessment

*Nature of Injury/History*Bleeding*Airway Obstruction*Loss of Consciousness*Sensory Deficits/

Changes*Medical /Surgical History*Physical Assessment

*Assessment

*Psychosocial Responses*Stress Factors*Behavioral responses

*Assessment

*Diagnostic Procedures*Radiological*Facial Bones*Water’s View*Skull series*C-spine*CXR*CT

*Assessment

*Diagnostic Procedures*Laboratory*Cultures*Coags*ABGs*T&C

*Priorities

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

*Age-related PearlsPediatric*6-7 year: primary eruption of teeth*Head is larger proportionally than adult’s*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

*Age-related PearlsGeriatric*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

*Sinusitis

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

*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)

*Sinusitis

Treatment*Decongestants*Antibiotics*HOB elevated*Apply heat*Room vaporizer*Severe: hospitalization

IV antibiotics Surgery

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

*Bell’s 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*> 40 yrs*Usually self-limiting*Complete resolution in 80-90% of cases

*Bell’s Palsy

Symptoms*Rapid, acute onset*Hx of Virus?*Unilateral facial

weakness/paralysis*Retro auricular and/or

facial discomfort*Drooling*Dysphagia

*Inability to close eye on affected side*Decreased lacrimation*Drooping of mouth*Speech difficulty*Positive corneal

sensation /negative blink*Inability to wrinkle

forehead

*Bell’s Palsy

*Diagnostics*Exclude other diseases

*Bell’s 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

*Trigeminal Neuralgia

*Fifth cranial nerve*Usually second and third division –

maxillary and mandibular areas*Brief, recurrent paroxysms of excruciating

facial pain*> 40 yrs and female*Right side affected more often

than left

*Trigeminal Neuralgia

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

Diagnosis*History and physical exam*Exclude other diseases

*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

* 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

* Facial lacerations and soft tissue injuries

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

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

*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

* Facial lacerations and soft tissue injuries

Education* Wound care

*Mandibular Fractures

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

*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

*Mandibular Fractures

Diagnostics*PA, lateral, oblique skull films*Waters’ *CT

*Mandibular FracturesTreatment*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

*Mandibular Fractures

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

*Maxillary Fractures

*Less common than mandibular*Usually associated with other multisystem

injuries*LeFort I, II, III*Common causes: fight and crashes

*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

*Maxillary Fractures

Diagnostics*Waters’ view*Individual facial films*CT scan

*Maxillary Fractures

Treatment/Education*Ensure airway patency*Prevent aspiration*Positioning – Fowler’s/Semi-Fowlers*Emergency intubation available*Control bleeding*Cold packs to face

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

*Zygomatic Fractures

*Causes: Fight, Crash, and Falls*Tripod fractures*Frequently associated with orbital floor

fractures – blow-out fractures

*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

*Zygomatic Fractures

Diagnosis*Waters’ view*Submentovertical view

*Zygomatic Fractures

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

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

*DENTAL AND ENT EMERGENCIES

*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

*ASSESSMENT

*Itching*Neck pain*HA

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

*DIAGNOSTICS

*Radiology*Chest*Waters’*CT scan

*Laboratory*Cultures*CBC*Sed rate*Coags*ABGs

*PRIORITIES

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

*Age-Related Pearls

*Pediatric*85% of FB aspirations < 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

*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

*Dental

*Odontalgia

*Toothache / Dental caries*Sharp to throbbing*If left untreated, will eventually lead to

necrosis*Prevention is best treatment

*OdontalgiaSymptoms*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

*Odontalgia

Treatment*Topical anesthetic*Antibiotics*Analgesic

Education*Preventative hygiene*Follow-up with dentist

*Tooth Eruption

*Primary teeth in infants and children*Wisdom teeth

*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

*Tooth EruptionTreatment*Gentle massage*Teething ring*Orajel*Tylenol/Ibuprofen*Warm saline mouth rinses*Soft solid diet

*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, Ludwig’s angina,

and peritonsillar abscess

*PericoronitisSymptoms*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

*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

*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

*Fractured Tooth

*Ellis Class III –*Enamel portion, dentin, and pulp*Dental Emergency

*Fractured ToothSymptoms/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

*Fractured Tooth

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

*Fracture involving pulp*High risk of infection*Apply Calcium Hydroxide

to exposed crown surface*Oral analgesic*Dental referral for

pulpectomy

*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

*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

*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

*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

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

*Dental Abscess

Diagnosis*Soft tissue X-ray*WBC*Culture

*Ludwig’s 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

*Dyspnea*Pallor or cyanosis*Tachycardia*Agitation

*Ludwig’s AnginaSymptoms*Pain and swelling of jaw and neck*Fever/Chills*Malaise*Dysphagia*Dysphasia*Elevation of tongue and floor of mouth toward palate

*Ludwig’s Angina

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

*Ludwig’s Angina

Treatment*Maintain airway(emergency cric)*Fowler’s position*Oxygen*I&D (with culture)*Antibiotic

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

*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

*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

*Acute Necrotizing Ulcerative Gingivitis

*Trench Mouth*Non-contagious*May follow a URI*Also associated with debilitating illnesses, emotional

stressors, nutritional deficiencies, and smoking

*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

*EAR

*Acute Otitis Externa

*Swimmer’s Ear*Inflammation of external auditory canal

and auricle of the ear

*Acute Otitis Externa

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

*Acute Otitis Externa

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

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

*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

*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

*Acute Otitis Media

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

*Ruptured Tympanic

Membrane

*Primarily caused by infection*May be caused from impact injury and

explosive acoustic trauma*Healing is usually spontaneous

*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

*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

*Foreign Body In Ear*Commonly seen in adults*Avoid irrigating vegetable FBs*Mineral oil or 2% Lidocaine for insects

*Foreign Body In Ear

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

*Foreign Body in Ear

Treatment/Education*Assist with removal*Irrigation*NS*Alcohol*Mineral oil*Lidocaine

*Suction*Use Flashlight for insect

*Meniere’s 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

*Meniere’s 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

Education* Safety R/T

vertigo, falling, meds

* Make position changes slowly

* Follow-up* Avoid alcohol and

caffeine * Hydration

*Meniere’s DiseaseTreatment

*Medications*Diuretics*Anti-emetic*Antihistamines*Vasodilator

*Bed Rest*Quiet environment*Surgery if severe and refractory to medical tx

*Labyrinthitis

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

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

*Labyrinthitis

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

*Labyrinthitis

Treatment*Antihistamines*Antiemetics*Sedatives*IVF*Antibiotics

*NOSE

*Rhinitis

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

*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

*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

*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

*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

*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

*Nasal Fracture

*Most frequently fractured bone

*Nasal Fracture

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

Diagnosis*Nasal/facial films

*Nasal Fracture

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

*Medications*Anesthetic*Decongestant*Vasoconstrictor*Analgesic*Antibiotics

*Foreign Body In Nose*Commonly seen in children

*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

*Throat

*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

*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

*Pharyngitis

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

*Tonsilitis

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

*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)

*Tonsilitis

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

*For chronic tonsilitis: tonsillectomy

*Laryngitis

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

tickling sensation

*Laryngitis

Symptoms/Assessment*Dry, tickling sensation in

throat*Partial to complete loss of

voice*Hoarseness*Fever/Chills*Sore throat*Dyspnea

*Difficulty swallowing*Dry cough*Anorexia*Reddened larynx and vocal

cords*Swelling of larynx and

epiglottis*Rhinorrhea*Throat cultures

*Laryngitis

Treatment/Education*Warm room that

humidified*Rest voice*Antibiotic*Inhaled steroid*Antitussive

*Antipyretic*Zinc*Ice to anterior throat*Humidifier

*Fractured Larynx

*Results from direct trauma (blunt or penetrating) to neck

*Common causes: MVC, strangulation, sports injuries

*Fractured Larynx

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

*Ecchymosis*Abrasions*SQ emphysema*Loss of normal prominence

of thyroid cartilage*Inspiratory stridor*Substernal or Intercostal

retractions

*Fractured Larynx

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

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

*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

*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

*Peritonsillar abscess

Diagnosis*Culture and sensitivity

*Peritonsillar abscess

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

*Warm saline irrigation*Antibiotics Topical anesthetic*Analgesic*Antipyretic*Ice collar to throat*I&D

*Foreign Body In Throat

*Common cause of accidental death in US Children < 6 y/o*Can lead to obstruction of mainstem

bronchus or distal trachea*Airway management is priority*Heimlich maneuver and/or

abdominal thrusts

*Foreign Body In Throat

Symptoms/Assessment*Sore throat*Vocal changes*Drooling*Coughing*Difficulty swallowing

and/or breathing*Difficulty talking*Known ingestion

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

*Foreign Body In Throat

Diagnosis*PA and lateral CXR*Soft tissue of neck

*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