Dr. Maha Al-Sedik

Objectives:  Anatomy, physiology of the ear.  Patient Assessment.  Pathophysiology of the ears.

Divided into three anatomic parts:  Outer ear  Middle ear  Inner ear Anatomy and Physiology of the Ear

 The ear is the primary structure for hearing and balance.  Disorders and injuries can leave a person unable to: Hear. Communicate. Maintain equilibrium.

1.Sound waves enter the ear. 2.Travel to the tympanic membrane. 3.Sound waves set up vibration in the ossicles ( stapes – incus – malus ). 4.Vibrations transmit to the inner ear. 5.At organ of Corti, vibrations form impulses. 6.Travel to the brain via the auditory nerve. How do we hear?

Patient assessment steps  Scene size-up  Primary assessment  History taking  Secondary assessment  Reassessment

Scene Size-up: A- Scene safety  Use standard precautions e.g. gloves and eye protection.  Use PPE (personal protective equipment).  Consider possibility of toxic substance through determination of the number of patients; toxic environments may produce multiple patients.  Consider potential for violence.

B- Mechanism of injury ( MOI )/nature of illness (NOI):  Nature of illness is often based on history of chronic medical problems.  Ensure that the eye emergency is not the result of a traumatic event.  Usually the NOI can be determined by the patient’s chief complaint or by asking family members or bystanders.

Primary Assessment I Form a General Impression II Airway and Breathing III Circulation IV Transport Decision

Form a General Impression:  Note the position of the patient, and identify any immediate life threats.  Determine priority of care based on the MOI/NOI.  A rapid scan of the patient will help you identify and manage life threats.  Assess the patient’s level of consciousness using the AVPU scale.  Obtain the chief complaint from the patient if possible.

 Alert to person, place, and day  responsive to Verbal stimuli  responsive to Pain  Unresponsive

Airway and Breathing:  Ensure the airway is open, clear, and self-maintained.  A patient with an altered level of consciousness may need emergency airway management.  when a cervical spine injury is suspected, open and maintain the airway using a modified jaw-thrust.  if nontraumatic situations, a head tilt–chin lift maneuver.

 Consider inserting a properly sized oropharyngeal or nasopharyngeal airway.  Suction as needed.  Evaluate the patient’s ventilatory status for rate and depth of breathing, respiratory effort.  Quickly assess the chest for accessory muscle use, and intercostal and abdominal muscle use.

 Assess lung sounds, and determine whether they are normal, decreased, abnormal, or absent.  Administer high flow oxygen at 15 L/min, providing ventilatory support as needed.

modified jaw-thrust

 Place the patient on his or her back.  Place one hand on the patient’s forehead and apply firm pressure backward.  Place the tips of your fingers under the bony part of the lower jaw.  Lift the chin forward and tilt the head back. Head tilt–chin lift maneuver

Oropharyngeal devices

Nasopharyngeal airway

How to select the suitable size?

Suction:  The purpose of suction is to remove vomit, blood, excretions, and other matter from the airway.  Here are some guidelines to use for suctioning:  Measure the tip from corner of mouth to earlobe  Oxygenate the patient well (if the situation permits)  Insert the tip into the oral cavity without applying suction  Move the suction tip side–to-side  Oxygenate well after suctioning

Suction

Circulation:  Evaluate distal pulse rate, quality (strength), and rhythm.  If distal pulses are not palpable, assess for a central pulse.  Establish vascular access.  Consider drawing blood samples.  Observe skin color, temperature, and condition.

Cyanosis

Transport decision: If the patient has an airway or breathing problem, signs and symptoms of internal bleeding, or other life threats, manage him or her immediately and consider rapid transport to the nearest hospital performing the secondary assessment en route to the hospital.

History Taking Investigate chief complaint ( sample – OPQRST):  Signs and symptoms  Allergies (med allergies)  Medications  Past medical history  Last meal or intake  Events leading to call SAMPLE

O – Onset When did it begin? P – Provocation What were you doing when it began? Q – Quality Can you describe the feeling you have? R – Radiation Does the feeling spread to any other parts of your body? OPQRST

S – Severity On a scale of 1-10, how bad is the trouble breathing? (1 is best, 10 worst). T – Time How long have you had this feeling?

Secondary Assessment I Physical Examinations II Vital Signs

Physical Examinations Observe ears for: Drainage Excess cerumen Inflammation Swelling Presence of hearing aid(s)

 Have patient rate his or her pain.  Ask about:  Changes in hearing.  Dizziness.  Inspect for:  Wounds.  Swelling.  Drainage.  Mastoid process.

Vital signs Document:  Pulse rate, rhythm, and quality  Respiratory rate, rhythm, and quality  Blood pressure  Temperature.

Pathophysiology of the ears

Foreign Body  Usually seen in pediatric patients  Assessment and management Determine the nature of the object. Look for bleeding, redness, or inflammation. Stabilize impaled objects in place. Transport in a position of comfort.

Impacted Cerumen  Yellowish oily substance found in outer ear.  May present as:  “Wet”: a sticky brown color.  “Dry”: a grayish flaky substance.  Can become impacted.

Risk factors include:  Abnormal ear canal shape.  Diseases that cause increased cerumen.  Improper use of cotton swabs.

Assessment and management: Symptoms may include: Pressure or fullness in the ears. Ringing in the ears. Loss of hearing.

Prehospital treatment includes:  Thorough history  Visual inspection of the ear

Labyrinthitis  Feeling of vertigo or loss of balance after an ear infection or upper respiratory infection.  Other symptoms may include: o Ringing in the ears. o Loss of hearing. o Vomiting.

Assessment and management:  Prehospital treatment is directed at: Reducing nausea and vomiting. Transporting the patient in a position of comfort  Serious disorders will need to be ruled out by a CT scan and an MRI.

Otitis Externa and Media Infection resulting from bacterial growth in the ear canal Externa: outer ear Media: middle ear More common in children than adults

Assessment and management Signs and symptoms may include:  Edema and erythema  Diminished hearing acuity  Inflamed, bulging tympanic membrane Pre hospital treatment: relieving unbearable symptoms

Perforated Tympanic Membrane Ruptured eardrum Results from:  Foreign bodies in the ear  Pressure related injuries  Diving-related injuries

Assessment and management Signs and symptoms include:  Loss of hearing.  Blood drainage from the ear.  Pain. Assess and treat other injuries. Transport for evaluation.