ENT Emergency

ENT

EMERGENCY

ENT EMERGENCY

• Epistaxis

• Foreign body in aerodigestive tract

Epistaxis

Epidemiology

Child and adult :

anterior epistaxis

Elderly : posterior

epistaxis

90% of epistaxis

occure at anterior site

More commom in

winter

Epistaxis

anterior epistaxis

posterior epistaxis

Blood supply of nose

• External carotid

artery

• Internal carotid

artery

Kiesselbach’s plexus

(Little’s area) • Most common site of

anterior epistaxis

• Blood supply

1. Anterior Ethmoidal a. 2. Superior Labial a. 3. Greater palatine a. 4. Sphenopalatine a.

Little’s area

Etiology

• Local causes

• Systemic causes

• Local causes

– Trauma (most common from nose

rubbing)

– Infectious/Inflammatory (URI , AR,

sinusitis)

– Septum deviation

– Neoplasm

– Vascular (anurysm)

– Dessication (cold, dry air)

– Foreign Bodies/other

Etiology

• Systemic causes

-Atherosclerotic vascular

disease ( HT, old age)

-Coagulation deficits

-Hereditary hemorrhagic

telangiectasia (Osler-weber-

Rendu)

-Idiopathic cause (10%)

Etiology

Hereditary hemorrhagic telangiectasia

Management

History

• Severity, location, duration, frequency

• History of allergy, sinusitis, nose rubbing, trauma

• Underlying disease

• Medication

Physical exam

• Complete ENT exam

• Identifed site of bleeding

Management

Investigation

• CBC

• Coagulogram

• Film sinus

• CT

Treatment

• Pressure

• Cauterization

- Chemical

- Electrocautary

- Laser

• Packing

• Ligation

• Embolization

Treatment

Pressure (first aids)

• Compression with or without

vasoconstriction agent

• Neck flexion and mouth open

• Cold pack

Treatment

Cauterizaton

• Chemical

- silver nitrate

- Trichloroacetic acid

• Electrocautery

• Laser

Working from peripheral to central

Avoid cautery on opposite surface

of septum

Treatment

Packing

• Anterior packing

- Vaselin gauze

- Absorbable material

(in coagulopathy)

Anterior packing

Anterior packing

bayonet forcepts

good light

T.C.A.

suction bovie/bipolar

silver nitrate

epistat

merocel

surgicel

speculum

Treatment

Packing • Porterior packing

- Roll gauze (traditional)

- Inflatable baloon

- Foley catheter

(12-14 Fr.,inflated with

8-15 ml. of water)

- Epistaxis catheter

Traditional posterior packing

1 2

3 4

Traditional posterior packing

5

6

Foley catheter

Epistaxis catheter

Treatment

Artery ligation

External carotid artery ligation

- Easy but high failure rate(45%)

Internal maxillary ligation

Failure rate 0-25%

Ethmoid artery ligation

Treatment

Embolization

Indication

1. Fail from other treatment

2. Contraindication to surgery

conclusion

Anterior epistaxis

pressure cautery ant.packing

fail

Posterior epistaxis

Post.packing ligation embolization

Foreign body

In aerodigestive tract

Foreign body

in aerodigestive tract

FB in airway passage

FB in food passage

FB in airway passage

• Nose

• Larynx and trachea

• Bronchus

FB in airway passage

Nose

- Most common in children 1-6 years - old

- Mx : restrain the child tightly

: appropriate light

: appropriate equipments

hook

alligator

FB in airway passage

Larynx trachea and bronchus

Initial evaluation : assess urgency • Respiratory distress

- dyspnea, restless, RR>25/min

- retraction & stridor

**Immdiate action plan for safe airway**

Evaluation of airway problem

• Hx : choking, coughing, cyanosis (immediately while eating food, playing toy)

• X-ray

: neck (AP, lateral), chest, abdomen

: decubitus film in both direction

- dependent lung : less aeration

- if these pattern reversed : FB can be suspected

FB in airway passage

Position of flat object

in going down the air and food passage

Children younger than 1 year

Five Back blows and Five chest thrusts

American Heart Association and American Academy of Pediatrics

Children older than 1 year

Five Abdominal thrusts

: supine position in

unconcious children

Five Abdominal thrusts :

upright position in

concious children

American Heart Association and American Acadamy of Pediatrics

Repeated Five “Heimlich maneuver”

Older children and adults

American Heart Association and American Academy of Pediatrics

Cricothyrotomy

• Open airway via cricothyroid mm.

• Risk to damage subglottis ,

converted to tracheotomy in 3-5

days

Palpate cricothyroid space with index finger

Transverse incision directly over the cricothyroid m.

Handle of the knife is inserted into the wound twisted

vertically to open the wound

Endotracheal tube is inserted and secured

Emergency Tracheotomy

• Better to perform elective tracheotomy

under LA. than emergency tracheotomy

• Needed good team work & co-operation

Emergency Tracheotomy

• Vertical incision : cricoid cartilage & extends inferiorly 1 – 1.5 inches

• Left hand to stabilize Larynx

• Make incision through skin, platysma, strap muscle, thyroid isthmus

• Stay in the midline

• Use left hand as a dissector & palpate trachea

• Vertical tracheal incision at 2nd and 3rd ring

• Tracheal Dilator help to insertion ET-tube

FB in food passage

Oral cavity & oropharyx

- Tonsil : most common site

- Have point of tenderness

FB in food passage

Esophagus

- FB those lodged in esophagus should be removed endoscopically

- large, sharp FB are removed surgically

- FB > 2.5 cm in diameter and 5 cm. in length probably not pass through the GI tract. So, endoscope or surgical removal should be done.