Non Traumatic EENT Emergencies Eyes--Ears--Nose--Throat

Eye Emergencies Acute Glaucoma Central Retinal Artery Occlusion Retinal Detachment

Acute Glaucoma Increased intraocular pressure Caused by acute obstruction of aqueous humor outflow Signs/Symptoms Decreased visual acuity Colored halos around lights Severe eye pain radiating to head/face Nausea, vomiting Fixed, midposition pupil “Steamy” cornea

Acute Glaucoma Management Cover eyes Transport

Central Retinal Artery Occlusion Blockage of blood flow to retina Signs/Symptoms Sudden, painless, unilateral blindness Management Intermittent digital massage over closed eyelid Caution - monitor EKG Consider having patient rebreathe in paper bag

Retinal Detachment Separation of retina from underlying structures Signs/Symptoms Dark or irregular “floaters” Flashes of light “Curtain” or “Veil” in visual field Management Transport gently

Ear Emergencies/Urgencies Otitis Externa Otitis Media Foreign Bodies

Otitis Externa Localized or diffuse infection of ear canal Predisposing factors Wetness Irritants (hair dye/sprays) Trauma from cleaning ears

Otitis Externa Signs/Symptoms Itching, severe pain Loss of hearing if ear canal swells Foul smelling discharge Tenderness with traction on ear

Otitis Media Bacterial or viral infection of middle ear Usually secondary to upper respiratory infection Common in children 3 months to 3 years old

Otitis Media Signs/Symptoms Persistent, severe earache Fever, nausea, vomiting, diarrhea Red, bulging tympanic membrane

Foreign Bodies Common in young children Attempts to remove may damage tympanic membrane Transport to ER for removal Non-hydroscopic objects may be irrigated out Insects can be killed by placing mineral oil in ear canal

Nose/Throat Emergencies Nasal foreign bodies Epistaxis Peritonsillar Abscess (Quinsy)

Nasal Foreign Bodies Common in young children Foul-smelling, bloody, unilateral discharge Retained foreign bodies Rhinoliths Transport for removal

Epistaxis Causes Local infection Drying of mucous membranes Hypertension Trauma Bleeding tendencies Digital insertion

Epistaxis Management Anterior Bleed Posterior Bleed Pinch nostrils Pressure over upper lip at base of septum Local cold application Posterior Bleed May require packs or cauterization Patients may need volume replacement

Peritonsillar Abscess (Quinsy) Acute infection of soft tissue spaces around tonsil Signs/Symptoms Severe pain on swallowing Fever Tonsil displaced medially Respiratory distress