Winter’s Wrap 23.08.2017: ENT

ENT: Not Just Epistaxis

A fantastic talk by senior ENT Registrar, Dr Anthony Rotman, about what we can do, what they can do and what we can do together.

OTITIS EXTERNA

Treat for 7 days if uncomplicated or 10 days of complicated or diabetic patient

avoid trauma and keep dry

insert wick

Perforated ear drum + OE: avoid sofradex (risk of ototoxicity), treat with ciprofloxacin

 

MALIGNANT OTITIS EXTERNA

May progress to osteomyelitis of temporal bone or skull base

Reg flags: Completely stenosed canal

Cellulitis of the pinna or peri-auriclar area

Ipsilateral severe head pain

Ipsilateral cranial nerve involvement

 

Weber test                                                                Rinne test

    

SUDDEN ONSET SENSORINEURAL HEARING LOSS

unilateral

may be irreversible of not recognised

Treatment: High dose steroids (may require intratympanic steroids) – do not delay for audiogram!

Early audiogram – notify ENT reg and will arrange for Wednesday (Sunshine) or Thursday (Footscray) or privately

 

EPISTAXIS

stepwise management:  local pressure

vasoconstrictors: cotton wool or spray cophenylcaine

reverse coagulopathy

cautery: beware complication of septal perf or vestibular stenosis

packing: Rapid Rhino – ensure completely inserted

surgery – endoscopic/open/angiographic embolisation

removing clot may restart bleeding

minimal evidence for antibiotics but consider staph cover

“Nasopore” dissolveable pack in theatre fridge

POTT’S PUFFY TUMOUR

  • Sinusitis PLUS facial swelling is NOT normal

 

POST TONSILLECTOMY BLEED

suction clot ONLY if impairing airway

cophenylcaine spray – may be complicated with throat anaesthesia and aspiration risk

– 1% adrenaline on gauze apply pressure with Magill forceps onto tonsillar fossa

Tranexamic acid gargle then swallow for local and systemic effect (crush 500mg tablet with saline)

ADMIT – esp kids as less blood volume and smaller airway

SUPRAGLOTTITIS

stridor + hoarse voice = problem in the larynx

usually unilateral (on scope)

may be associated with retropharyngeal collection, quinsy, sialadenitis

management: Sit patient up

Hydrocortisone 100-250mg IV
Nebulised adrenaline 5mg

consider high flow nasal prongs to keep airway open

 

BASIC SKILLS WORKSHOP

coordinated by Hans

Blood Gases

ECGs

Xray’s

Critical Care Cases

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