Emergency situation in ENT

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Emergency situation in ENT

• Azita Gebauerová
• 3rd Medical Faculty of Charles
  University
• Prague

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• Dyspnoe
• Acute laryngitis
• Subglottic laryngitis
• Acute epiglotitis- supraglottic laryngitis
• Allergic oedema of larynx
• Laryngospasmus
• Tumors
• Trauma
• Burns
• Aspiration
• Foreign bodies

• Bleeding
• Ear
• Nose
• Larynx trachea
• Esophagus
• Sudden loss of hearing
• Acute vertigo
• Vestibular
• M. Menieri

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Bleeding

• Epistaxis
• From nasopharynx
• From vessels of rinobase
• From larynx
• Hemoptysis
• Hemoptoe
• Hematemesis

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Epistaxis

• Downer 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

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Causes

• Causes
• Arterial (intermitent, sudden, intenzive)
• Venous(continual, longer lasting, less intenzive)
• Local (esencial, polyp, TU, microtrauma, atrofic
  inflammation, injuries)
• Systemic(hypertension, coagulopathy, liver and
  kidney diseases, m. Rendu-Osler)

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Treatment

• Localisation- per exclusionem- BP, anamnesis
  (physician)
  - rhinoscopy,endoscopy
  (specialist)
• - laboratory tests
• Therapy-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

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Dyspnoea

• Dif.dg. of respiratory dyspnoea
• Upper and lower part of airways
• - Subglottic laryngitis
• - Supraglottic laryngitis (epiglottitis)
• -Laryngotracheitis crustosa

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Stages of laryngeal dyspnoea

• Compensatory
• prolongation of breath, insp.stridor,
  saturation of O2..
• Decompensatory
• accelerative breathing, sweating, paleness,
  stridor insp. exspir., anxiety, ...
• Asfyxy
• paradoxical pacification, cyanotic color,
  attenuation of breathing

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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

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Laryngitis supraglottica (epiglottitis)

• -bacterial (H. influenzae, Str. heamolyticus)
• -all groups, max. to 10 y
• -symptoms sorethroat, odynofagy, fever,
  inspiratory stridor, salivation, problems with
  swallowing
• -therapyhospitalization!,
• ICU-monitoring of vital functions
• ATB, steroids 1000mg/day, antihistaminics,
  intubation, hydratation minerals

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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
• -TherapyATB, inhalation, mucolytics and
  expectorans, O2, tracheobronchoscopy

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Laryngospasm

• Aetiologyirritation 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

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Laryngeal injuries

• Opened cutted wounds of neck-accidents-danger of
  blood aspiration
• Symptoms dyspnoea, hoarsness, haemoptysis,
  foaming blood, emfysema, shock
• Therapy surgical revision of the wound,
  treatment of the bleeding, tracheostomy, O2,
  steroids, ATB
• Closed dislocated fractures of cartilages,
  haematoma, rupture of mucose,iatrogenic invasive
  procedures
• Symptoms painfull speaking, haemoptysis, stridor
• Dg laryngoscopy, CT
• Therapy observation, tracheostomy, surgical
  reconstruction,
• steroids, ATB,inhalations

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Laryngeal oedema

• Dyspnoea, dysfagia depends on extention
• Acute-allergic
• Progressive-postradiation
• Patogenesis toxins of insects, allergic reaction
  (food alergens)-Quincke angioneurotic oedema,
  lymfostasis (postiradiation), injury, burning by
  chemicals
• Dg-laryngoscopy
• Th-ICU, steroids,antihistaminics, nebulisation

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Foreign bodies in airways

• Mostly in childhood-toys, beans, peanuts(risk of
  bronchitis)
• To the right bronchus and lung
• Symptomsirritative 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

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Esophageal injury

• PERFORATING-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,
  endoscopy
• Therapy ATB, esofagoscopy, surgical
  revision-thoracotomy event. Lateral cervikotomy
• NO PERFORATING-Corrosive- burning with acid,
  alkalies, chemicals, suicide
• Symptoms anamnesis, sharp pain, salivation,
  dysphagia, oedema, mucosal erytema ,
  perforation-peritonitis
• Therapyfirst aid- neutralization-water, milk,
  citric acid, antacid, intubation or tracheotomy,
  NG, steroids, ATB
• !!! stenosis-dilatation, reconstruction with
  graft

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Foreign body in oesophagus

• Every age
• -fish bone, cervical part of
  esophagus-bones, coins, stone( esofagoscopy under
  GA), prisoners
• Symptoms anamnesis, dysfagia, salivation
• DgX-ray in two ways, wisp of cotton with
  contrast
• Suspicion for perforation- sine baryum
• Therapy rigid esofagoscopy , ATB, NG tube

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Treatment of dyspnoea

• Decompensative- due to conditions
• In hospital
• 1.intubation
  2. tracheotomy

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Coniotomy

• Coniotomy
• Coniopunction