Keywords: epistaxis (PubMed Search)
Epistaxis can be a difficult thing to control in the ED, but there are several techniques you can learn that will make your life easier.
The majority of epistaxis cases are from kiesselbach's plexus therefore you can control it with:
Direct Pressure: Can be held with two fingers pinching the nares, or you can tape 4 tongue blades together and make your own "clothes pin" that can then be used to pinch the nares.
Vasoconstrictor and Anesthesia: A 1:1 mixture of topical lidocaine 4% and oxymetazoline can often be mixed together in the same oxymetazoline spray container enabling you to just spray it into the nares. This will often slow or stop the bleeding and provides anesthesia in case you need to cauterize the bleeding site. Some IV/IM narcotic pain medication will also help increase patient cooperation.
Visualize the bleeding site: Use a HEAD LAMP with an appropriate sized nasal speculum. You may look like Marcus Welby, MD but nothing works as well to see into the nose.
Cauterization It is best to cauterize circumferential around the bleeding site prior to directly cauterizing the actual site. Be careful with electrical cautery so has not to perforate the septum.
Nasal Packing: Instead of using surgilube to lubricate the packing; use Muprion, Bactroban or Bacitracin ointment to lubricate the packing. This will reduce the chance of Toxic Shock Syndrome.
Keywords: Mandible, Dislocation, Unified, Hand (PubMed Search)
Some authors also recommend using rolled guaze to hold the patient's mouth shut so that they do not inadvertantly dislocate their jaw a second time if they happen to yawn while awakening from their sedation.
Cheng D. Unified hands technique for mandibular dislocation. J Emerg Med. Mar 19 2009.
Keywords: Iritis, diagnosis (PubMed Search)
Patient with iritis will typically present with a painful red eye and it can sometimes be difficult to tell if it is due to conjunctivitis or a corneal abrasion. Some tips that can help differentiate iritis from other causes of painful red are:
Finally, ensure you document:
Adapted from Pfaff J and Moore G. Eye, Ear, Nose and Throat. Emergency Medicine Clinics of North America. Volume 15, Issue 2 (May 1997)
Keywords: Conjunctivitis (PubMed Search)
Patient presenting to the Emergency Department complaining of "Pink Eye" is very common but how can you be sure that they do not have a bacterial conjunctivitis and absolutely need antibiotics or are they just suffering from a viral or allergic conjunctivitis.
Keywords: Otitis Externa, Malginant (PubMed Search)
Infections of the external ear canal are common and can typically be treated with topical antibiotic solutions (Cortisporin Otic, Cipro Otic, etc...) or antibiotic solutions mixed with topical steroids (Cortisporin HC Otic, Cipro HC Otic, etc...). Most patients should not require PO or IV antibiotics.
However, you need to always be on the look out for malginant otitis externa (MOE) which is a more deep seated infeciton extending into the temporal bone and can have a mortality rate as high as 50%. Patients that are diabetic, immunospressed, or have had radiation therapy to the base of the skull are at increased risk. Patients with MOE typically have pain out of proportion to clinical findings and granulation tissue may be present in the ear canal. Suspect this diagnosis in patients that have cellulitis or extreme tenderness over the mastoid process.
If you suspect MOE the patient should be started on antibiotics that cover pseudomonas. Consider obtaining a CT scan with temporal bone cuts and an Otolaryngology consultation.
Keywords: Avulsed Tooth, hanks solution, dental emergencies (PubMed Search)
Dental Emergency -- Avulsed Tooth
Keywords: Trigeminal Neuralgia, Microvascular decompression, treatment (PubMed Search)
Keywords: Sinusitis, Antibiotics, Viral, URI (PubMed Search)
Keywords: PTA, Abscess, ENT, Peritonsillar (PubMed Search)
Keywords: Epistaxis, Nose, Bleeding (PubMed Search)