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ENT (Otitis Externa (Otitis Media (Path: URI bugs in middle ear (Tympanic…

- - - - Pt: unilateral ear px, relieved by pulling on the pinna :boy::skin-tone-2:
        No relief comes w/ pulling, but it doesn't hurt more
        
        Visualize swelling on otoscope
        
        loss of light reflex
        
        bulging erythematous TM
        
        fluid behind ear
        
        none of these are pathognomonic
        
        (Pretest FM) ~~Erythema~~: not specific
        
        crying baby can cause red ear
        
        Dx: Clinical- Pneumatic Insulflation
        
        puffing air into ear canal, TM doesn't move
        
        Tx: (difficult)
        
        1st line Amoxacillin:pill:
        
        recurrent (or toxic):
        
        + clavulonate
        
        refractory:
        
        Ear tubes (~~tympanoplasty~~) if
        
        3x/6mo or
        
        4x/1yr
        
        :pencil2:
        
        PCN allergic pt:
        
        if not lifethreatening, use cephalosporin (Cefdinir).
        
        Anaphylaxis? (or 2nd line)
        
        Azithromycin
        
        (Pretest FM): Ear px is a px in the ass!
        
        Effusions w/o s/s of infx are normal < 3 mo.
        
        no additional Abx
        
        refer to otolaryngology if > 3 mo effusions
        
        myringotomy: placing a pressure equalizing (PE) tube in the TM. Not = tympanoplasty (repairing perforated TM)
        Source: getting PIMPed in ENT rot.
  - - - Dx: Clinical
        
        Tx: resolves spontaneously
        
        if not, or Toxic presentation: ear drops :droplet::ear:
        
        Abx :pill::
        
        :droplet:Cipro (pseudo coverage)
        
        steroids :droplet: (reduces eustacian t. swelling)
        
        f/u r/o Mastoiditis (sx emergency)
        
        Path: Same bugs as OM/OE
        
        ear tubes is risk factor
        
        infx of mastoid bone
        
        Pt: Same as OM, w/ mastoid swelling
        
        swelling behind ear
        
        may have anterior rotated ear
        
        1 more item...
- - - - Dx: :warning:~~Imaging~~
        
        CT/XR are not correct
        
        would see air fluid levels, or opacifications
        So... clinical dx
        
        Tx: Supportive
        unless obv. bacterial
        
        thick purulent
        
        w/ fever (>38ºC)
        
        duration > 10d
        
        improves then worsens or simply worsens
        
        any 1 sx = ABx
        :pill:Amoxicillin Clavulonate
  - - - Pt: Congestion :sneezing_face:
        
        bilat clear rhinorrhea
        
        copious and runny
        
        Dx: Clinical
        ~~imaging~~
        
        don't get tricked by PCR, nasal washings (unnecessary)
        
        don't get culture swab
        
        trick is to see that this is non-toxic
        
        Tx: Supportive
        
        :pencil2:Exception: recurrent sinusitis, get CT.
        
        esp recurrent bact infx
        
        find anatomical defect impairing drainage
        
        Bacterial Sinusitis in kids :boy::skin-tone-2: = foreign body :earth_asia:
    - - Path: Viral(common) or Strep A (Rheumatic fever)
        
        :pencil2:Risk of RF improved w/ Abx. Risk of PSGN not improved w/ Abx
        
        Pt: Sore throat
        
        odynophagia
        
        :warning:CENTOR criteria (HY)
        
        C – Cough absent, or the incorrect but memorable "Can't Cough"
        
        E – Exudate
        
        N – Nodes
        
        T – temperature (fever +38º)
        
        2 more items...
        
        +1
        
        +1
        
        +1
        
        :pencil2:(Aquifer):modified CENTOR criteria has changed so
        
        Abx is never the first step for any score
        
        >2 pts = Rapid strep test
- - - - Path: :boy::skin-tone-2: Kids stick things places
        
        unattended kid, missing object
        
        Pt: unilat bacterial infx
        
        Dx: Clinical inspection
        
        Tx: Abx & retrieve obj
        
        forceps
        
        endoscopy (trachea)
        
        rigid bronchoscopy (GI)
        
        Alt Path: Homeless :older_man::skin-tone-2:put coins in :ear::skin-tone-2: to prevent :spider: from entering
        
        Pt: Scratching or buzzing
        
        insect in ear canal
        
        :warning:Don't shine a light in canal :forbidden::flashlight:
        
        insect will burrow
        
        Tx: Lidocaine to paralyze insect, retrieval
    - - Pt: unilat epistaxis <30 min
        
        Dx: Clinical
        
        Tx: Lean forward and apply pressure or ice
        
        leaning back aspirates blood/ cough dislodges clot
        
        F/u: nonstop bleeding
        
        anterior bleed: Cauterize :fire:
        
        Post bleed: Packing & Abx for toxic shock prophy
  - - - Pt: Blue baby when feeding. :baby::skin-tone-3::baby_bottle:
        
        pink when crying
        
        Child that snores :sleeping:
        
        Dx: Catheter fails to pass
        
        fiber optic wire for stenosis
        
        Tx: Surgical repair