NR511 Midterm-HEENT

Bacterial Conjunctivitis risk factors 1. Direct contact 2. Contact lens 3. Eye rubbing 4. Trauma Bacterial Conjunctivitis findings 1. Purulent eye exudate: c/o "stuck shut" in am 2. Sensation of foreign body in eye 3. Reddened conjunctiva 4. Eyelid swelling 5. Starts on one side, becomes two sides Bacterial Conjunctivitis diagnostics 1. Clinical 2. Can culture exudate if really bad 3. If recurrent: immunocomp testing 4. Fluorescnce test for herpes simplex or chlamydia Bacterial Conjunctivitis treatment 1. Self-limiting; can wait 3 days before treatment 2. Azithromycin gtts (BIDx2d, QDx5d) 3. Polytrim/trimethoprim/polymixin 4. Erythromycin 5. Tobramycin 6. gentamicin 7. Sodium sufacetamide 8. Ciprofloxacin 9. Contact lens wearer: fluoroquinolones (Levofloxacin) 10. Children: ointment over gtts. Bacterial Conjunctivitis education 1. Hand hygiene 2. Clean washcloth 3. Change pillowcase, contacts, make up 4. Warm compress 5. Avoid contacts 6. Proper use of eye drops 7. Improvement in 2-4 days 8. Return to activities in 24 hrs after abx Corneal abrasion risk factors 1. Contacts 2. Trauma incident 3. Spontaneous 4. Recurrent erosions 5. Young, active adults Corneal abrasion findings 1. "Gritty" feeling or "something" in eye 2. Eye pain 3. Photophobia 4. Constricted pupil 5. Red eye 6. Foreign body in eye 7. Lacrimation Corneal abrasion Diagnostics 1. Visual acuity 2. Fluorescein after penlight/fundus exam (confirms dx) Corneal abrasion Treatment 1. Saline to irrigate eye 2. ABX gtt/oint 5-7 days 3. Analgesics 4. Tetanus prophylaxis Corneal abrasion foreign body abx 1. Erythromycin 2. Sulfacetamide Corneal abrasion Contact abx 1. Ofloxacin 2. Ciprofloxacin 3. Tobramycin Corneal abrasion education 1. Protective eyewear 2. Strict lens maintenance 3. Avoid contacts until resolved 4. Ointment lubricates Epiglottitis risk factors 1. Stretococci infection 2. 7 y/o (can be adults) 3. Menwomen 4. Foreign body asp 5. Inadequate vaccines (HIB) 6. Immunosuppression 7. Direct blow to neck 8. Ingestion of chemicals 9. Smoke drugs 10. Tx for head/neck cancer Epiglottitis findings 1. Sore throat and odynophagia 2. Abrupt onset of high fever and sore throat 3. Anxiety/restlessness, toxic appearance 4. Dyspnea 5. "sniffing posture" 6. Drooling (80%) 7. Red/swollen epiglottis 8. Ant. neck adenopathy 9. Beefy red pharynx 10. Muffled voice 11. Stridor 12. Tachypnea Epiglottitis Diagnostics 1. Clinical 2. DO NOT attempt to visualize pharynx if epiglottitis is suspected!! 3. Lat neck X-Ray 4. CBC (do not venipuncture until secure airway) Epiglottitis treatment 1. Secure airway! 2. ABX 3. EMERGENCY CARE! Epiglottitis education 1. HIB Vaccine! Eustachian tube disorder risk factors 1. Allergic rhinitis 2. Sinusitis 3. URIs 4. Enlarged adenoids 5. Pregnancy 6. Recent travel in airplane 7. Scuba diving Eustachian tube disorder findings 1. Decreased hearing or fullness in ears 2. Hearing may be muffled/diminished 3. Inability to "pop" or "clear" ears 4. Accompanying tinnitus or disequilibrium 5. NP exam: allergic rhinitis, sinusitis, or URI 6. TM appears retracted or "sucked back" Eustachian tube disorder Diagnostics 1. Pneumatic otoscopy: TM immobile 2. Conductive hearing loss on affected side: Weber: Tone heard best in affected ear Rinne: Tone heard through bone as long as or longer than air Eustachian tube disorder treatment 1. Treat underlying problem 2. Cold: Netipot, nasal saline gtts 3. AOM/Sinus infect: abx 4. Allergic rhinitis: nasal steroids/decongest 5. Pain manage: Tyl/Adv Eustachian tube disorder education 1. Release pressure by yawning, chewing, or sneezing 2. Don't plug nose and blow out d/t risk of TM perf. 3. If chronic: ENT refer! Hyphema risk factors 1. Trauma Hyphema findings 1. Pain 2. Photophobia 3. Vision changes 4. Blood between cornea and iris Hyphema diagnostics 1. ER 2. Ophalmologist Meniere's Disease Risk factors 1. Inflammatory response of inner ear 2. Blunt trauma 3. Viral infection 4. Allergies 5. Reduced or negative middle ear pressure 6. Various vascular, endocrine, and lipid disorders 7. Genetic disposition 8. Migraine headaches 9. Autoimmune conditions 10. Thyroid disorders 11. High salt, caffeine, or alcohol 12. Loud noise exposure Meniere's Disease Findings 1. Triad of symptoms: Vertigo, hearing loss, and tinnitus 2. Acute attacks: 20 min-3hrs 3. Frequency and severity may decrease w/ time 4. Hearing loss: low frequency (may improve immediately after attack) 5. Otoscopic exam normal (unless AOM present)