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