chapter 19 diseases of the eyes, ears, nose, and throat

Chapter 19Chapter 19

Diseases of the Eyes, Ears, Nose, and Throat

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

Medicine

Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint.

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

Diseases of the Eyes, Ears, Nose, and Throat

Knowledge of the anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of

− Common or major diseases of the eyes, ears, nose, and throat, including nose bleed

IntroductionIntroduction

• Calls may involve disorders of the eyes, ears, nose, and throat (EENT).− Patients may need to be transported to an

emergency department with access to a specialist.

Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

• The globe measures about 1 inch in diameter.− Housed within the orbit

− Held in place by connective tissue and muscles• Control eye movement

Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

• Oculomotor nerve (third cranial nerve)− Cause motion of the eyeballs and upper eyelids

• Optic nerve (second cranial nerve)− Provides the sense of vision

Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

• Eye structures − Sclera (“white of

the eye”)

− Cornea

− Conjunctiva

− Iris

− Pupil

− Lens

− Retina• Converts light

impulses to nerve signals

Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

• Anterior chamber: between lens and cornea− Filled with aqueous humor

• Posterior chamber: between iris and lens − Filled with vitreous humor

Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

• Light rays enter the eyes through the pupil.− Focused by the lens

− Image is cast on the retina

− The optic nerve transmits the image to the brain.

− The visual cortex coverts it into a conscious image.

Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

• Two types of vision− Central vision

• Enables visualization of objects directly in front of you

− Peripheral vision• Enables visualization of lateral objects while a

person is looking forward

Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

• Lacrimal apparatus− Secretes and

drains tears from the eye

− Tears moisten the conjunctivae.

Patient AssessmentPatient Assessment

• Ensure scene safety.

• Keep your patient calm.

• Form a general impression.

• Assess airway and breathing.

• Cover both eyes.

• Consider pain management.

• Cardiac monitoring is recommended.

Patient AssessmentPatient Assessment

• Obtain chief complaint and history.− OPQRST

− Diabetes is the leading cause of new cases of blindness in adults.• Diabetic retinopathy

Patient AssessmentPatient Assessment

• Symptoms that may indicate a serious ocular condition:− Visual loss that does not improve with blinking

− Double vision

− Severe eye pain

− Foreign body sensation

• Perform a thorough examination.

Patient AssessmentPatient Assessment

• Assess for:− Pain/tenderness

− Swelling

− Abnormal or loss of movement

− Sensation changes

− Circulatory changes

− Deformity

− Visual changes

− Airway compromise

Patient AssessmentPatient Assessment

• Assess structures:− Orbital rim

• Ecchymosis, swelling, lacerations, and tenderness

− Eyelids• Ecchymosis,

swelling, lacerations, or any abnormalities

− Corneas• Foreign bodies

Patient AssessmentPatient Assessment

• Assess structures:− Conjunctivae

• Redness, pus, inflammation, and foreign bodies

− Globes• Redness,

pigmentation, and lacerations

− Pupils• Size, shape,

equality, and reaction to light

Patient AssessmentPatient Assessment

• When assessing ocular function, test:− Visual acuity

• Ability to see large and small letters

− Peripheral vision• Ability to recognize an object entering the visual

field

− Ocular motility• Ability to move the eyes in all directions

Patient AssessmentPatient Assessment

• Obtain a full set of baseline vital signs.

• The patient may experience side effects if:− Used more than one eye medication

− Used too much medication

• Ask how he or she administered the medication.

Patient AssessmentPatient Assessment

• Eye drops and lubricants can be applied by:− Gently squeezing the lower eyelid

− Applying the medication

− Have the patient close the eyes and roll them.

− Apply gentle pressure to the corner of the eyes to prevent drainage.

Patient AssessmentPatient Assessment

• Irrigation may be necessary.− Use sterile water or isotonic saline solution.

− Flush from the inside corner to the outside.

• Eye injuries should be seen in the emergency department.

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

• Can be caused by:− Chemicals

− Heat

− Light rays

• Thermal burns− Occur when a

patient is burned in the face during a fire

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

• Retinal injuries caused by extremely bright light:− Generally not painful

− May result in permanent damage

• Superficial burns of the eye:− May not be painful

initially

− Symptoms include:• Conjunctivitis

• Redness

• Swelling

• Excessive tear production

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

• Assessment and management− Assess for and treat life-threats.

− May be difficult if eyes are closed• Open the eye and irrigate with sterile water or sterile

saline solution.

• Pain may have to be managed before assessment.

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

• Assessment and management (cont’d)− Assess positions of gaze.

− Cover an eye burned by ultraviolet light with: • Sterile, moist pad

• Eye shield

− Transport in a supine position.

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

• Assessment and management (cont’d)− Chemical burns require immediate irrigation.

• Direct as much fluid as possible.

• Use a device that will control the flow.

• Do not allow contaminated fluid to enter the eye.

• Irrigate for at least five minutes.

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

• Assessment and management (cont’d)− Use of the Morgan lens (eye irrigation device)

• Administer a topical anesthetic.

• Connect the lens to the IV bag, and let it drip.

• Slide the Morgan lens under the eyelids.

• Run the fluid at the desired rate.

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

• Assessment and management (cont’d)− Transport considerations for eye burn patients:

• Prevent one eye from draining into the other eye.

• Specialized treatment can be found at level-1 trauma centers.

Burns of the Eye and AdnexaBurns of the Eye and Adnexa

• Assessment and management (cont’d)− Contact lenses

• To remove a hard lens, use a small suction cup.

• To remove soft lens, pinch between thumb and index finger and lift off eye.

ConjunctivitisConjunctivitis

• Conjunctiva becomes inflamed and red.− Often starts in one

eye and spreads to the other eye

− Often caused by bacteria, viruses, allergies, or foreign bodies

Courtesy of John T. Halgren, M.D., University of Nebraska Medical Center

ConjunctivitisConjunctivitis

• Assessment and management− Rule out life threats or dangers to the crew.

− Perform general assessment of vision.

− Viral conjunctivitis resolves on its own

− Bacterial conjunctivitis: topical antibiotic

− Allergic conjunctivitis: topical antihistamine

Corneal AbrasionCorneal Abrasion

• Painful

• Due to superficial trauma to the cornea

• If discomfort does not resolve, patient should be seen in the emergency department.

Corneal AbrasionCorneal Abrasion

• Assessment and management− Symptoms include:

• Pain

• Sensitivity to light

• Tearing

− Lubrication can alleviate some pain.

− Taping the eyelid closed can keep the eye from drying out.

Corneal AbrasionCorneal Abrasion

• Assessment and management (cont’d)− Invert the eyelids to expose the source.

− Look for a foreign body in the eye.

− A topical anesthetic may relieve symptoms.

− If movement of the eye causes discomfort, cover both eyes.

Foreign BodyForeign Body

• Can cause significant pain

• Commonly caused by machines such as:− Grinders

− Sanders

− Nailers

− Weed whackers

Foreign BodyForeign Body

• Assessment and management− Evaluate the entire eye using a light.

− Examine the undersurface of the upper eyelid.• If you spot a foreign object on the surface, attempt

to remove it with a moist, cotton-tipped applicator.

Foreign BodyForeign Body

• Assessment and management (cont’d)− To assist with dislodging:

• Irrigate the eye with a sterile saline solution.

• Transport the patient to the hospital.

Foreign BodyForeign Body

• Assessment and management (cont’d)− Do not remove an impaled foreign body.

• Stabilize in place.

• Cover with a moist, sterile dressing.

• Place a protective barrier over the object.

• Cover unaffected eye.

• Transport promptly.

Inflammation of the Eyelid (Chalazion and Hordeolum)Inflammation of the Eyelid (Chalazion and Hordeolum)

• Oil glands and oil ducts may become blocked, causing:− Chalazion: swollen

bump or pustule on the external eyelid

− Hordeolum (stye): red tender lump in the eyelid or the lid margin

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Inflammation of the Eyelid (Chalazion and Hordeolum)Inflammation of the Eyelid (Chalazion and Hordeolum)

• Assessment and management− Often painful

− Can progress to become systemic

− Thorough assessment of vital signs and history

− Treat inflammation with a warm washcloth.

− Transport to the emergency department.

GlaucomaGlaucoma

• Group of conditions that lead to increased intraocular pressure

• Usually treated with eye drops to reduce ocular pressures

GlaucomaGlaucoma

• Assessment and management− Perform a general eye assessment.

− Ask patients what medications they have taken.

− Treatment in the pre-hospital setting:• Administer tetracaine for pain relief.

• Irrigate for the removal of an irritating substance.

HyphemaHyphema

• Bleeding into the anterior chamber of the eye − Obscures vision

− Blood clotting is a concern.• Can cause a rise in

intraocular pressure

HyphemaHyphema

• Assessment and management− Pain and blurred vision is likely.

− Blood may be visible.

− If rupture of the globe is suspected, take spinal motion restriction precautions.

HyphemaHyphema

• Assessment and management (cont’d)− If no contraindications, transport upright.

• Other medications with antiplatelet effects should be avoided.

− An anxiolytic may facilitate transport.

IritisIritis

• Inflammation of the iris− Acute causes include:

• Trauma

• Irritants

− Chronic causes include:• Autoimmune diseases

• Arthritis

• Irritable bowel disease

• Crohn disease

© Biophoto Associates/Photo Researchers, Inc.

IritisIritis

• Assessment and management− Red area surrounding the iris, cloudy vision, or

an unusually shaped pupil

− Focus on history.• Acute iritis may respond to topical corticosteroids.

• Chronic iritis should be referred to a specialist.

PapilledemaPapilledema

• Swelling or inflammation of the optic nerve

• Patients experience:− Headaches

− Nausea

− Temporary vision loss or narrowing vision fields

− A “graying” in the field of vision

PapilledemaPapilledema

• Can be caused by:− Abscess

− Tumor

− Inner ear infection

− Lung infection

− Dental infection

• Other causes:− Meningitis

− Fever

− Hypertensive crisis

− Chronic high blood pressure

− Guillain-Barré syndrome

PapilledemaPapilledema

• Assessment and management− Prehospital management consists of:

• Treat symptoms.

• Transport.

• Assess ABCs and life threats.

• Administer analgesics or a mild sedative, if needed.

Retinal Detachment and DefectRetinal Detachment and Defect

• Potential result of blunt eye trauma

• Assessment and management:− Generally painless

− Produces:• Flashing lights

• Specks

• “Floaters”

− Requires immediate medical attention

Cellulitis of the OrbitCellulitis of the Orbit

• Periorbital cellulitis− Presents as a painful,

red, swollen eyelid

− Risk factors:• Insect bites

• Upper respiratory disorders

• Trauma

• Orbital cellulitis− Medical emergency

− Risk factors:• Sinusitis

• Tooth infections

• Ear infections

• Trauma

• Sinus infections

Cellulitis of the OrbitCellulitis of the Orbit

• Assessment and management− Treatment includes antibiotics.

− Prehospital management includes: • Ruling out life threats

• Obtaining a thorough history

• Transporting to the appropriate care

The EarThe Ear

• The ear is the primary structure for hearing and balance.− Disorders and injuries can leave a person

unable to:• Communicate

• React

• Maintain equilibrium

Anatomy and Physiology of the EarAnatomy and Physiology of the Ear

• Divided into three anatomic parts

Anatomy and Physiology of the EarAnatomy and Physiology of the Ear

• Sound waves enter the ear.− Travel to the tympanic membrane.

− Sound waves set up vibration in the ossicles.

− Vibrations transmit to the cochlear duct.

− At organ of Corti, vibrations form impulses.

− Travel to the brain via the auditory nerve.

Patient AssessmentPatient Assessment

• Observe the scene for hazards.

• As you approach, assess:− Age and sex of the patient

− Environmental conditions

− Degree of distress

− Presence of hearing aid(s)

Patient AssessmentPatient Assessment

• Ensure ABCs and manage life threats.

• Take a complete history.

• Observe ears for:− Drainage

− Excess cerumen

− Inflammation

− Swelling

Patient AssessmentPatient Assessment

• Have patient rate his or her pain.

• Ask about:− Changes in hearing

− Tinnitus

− Dizziness

• Inspect for:− Wounds

− Swelling

− Drainage

− Mastoid process

• Transport.

Foreign BodyForeign 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 CerumenImpacted Cerumen

• Yellowish oily substance found in outer ear

• May present as:− “Wet”: a sticky brown color

− “Dry”: a grayish flaky substance

• Can become impacted

Impacted CerumenImpacted Cerumen

• Risk factors include:− Abnormal ear canal shape

− Diseases that cause increased cerumen

− Improper use of cotton swabs

Impacted CerumenImpacted Cerumen

• Assessment and management− Symptoms may include:

• Pressure or fullness in the ears

• Ringing in the ears

• Loss of hearing

Impacted CerumenImpacted Cerumen

• Assessment and management (cont’d)− Prehospital treatment includes:

• Thorough history

• Visual inspection of the ear

LabyrinthitisLabyrinthitis

• Feeling of vertigo or loss of balance after an ear infection or upper respiratory infection− Other symptoms may include:

• Ringing in the ears

• Loss of hearing

• Vomiting

LabyrinthitisLabyrinthitis

• 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.

Meniere DiseaseMeniere Disease

• Endolymphatic rupture creates increased pressure in the cochlear duct− Damages organ of Corti and semicircular canal

− Patients will likely experience:• Severe vertigo

• Tinnitus

• Sensorineuronal hearing loss

Meniere DiseaseMeniere Disease

• Assessment and management− Prehospital care includes an antiemetic.

− Physician may treat with diuretics and an antiemetic.

Otitis Externa and MediaOtitis Externa and Media

• Infection resulting from bacterial growth in the ear canal− Externa: outer ear

− Media: middle ear

• More common in children than adults

Otitis Externa and MediaOtitis Externa and Media

• Assessment and management− Signs and symptoms may include:

• Edema and erythema

• Diminished hearing acuity

• Inflamed, bulging tympanic membrane

− Prehospital treatment: relieving unbearable symptoms

Perforated Tympanic Membrane

Perforated Tympanic Membrane

• Ruptured eardrum

• Results from:− Foreign bodies in the ear

− Pressure-related injuries

− Diving-related injuries

Perforated Tympanic Membrane

Perforated Tympanic Membrane

• Assessment and management− Signs and symptoms include:

• Loss of hearing

• Blood drainage from the ear

• Pain

− Assess and treat other injuries.

− Transport for evaluation.

The NoseThe Nose

• Susceptible to injury because of prominence− Allergens, particles, and chemicals can cause

inflammation, infection, and injury.

• Inside of the nose is extremely vascular.− Excellent route for some medicines.

The NoseThe Nose

• Smelling disorders include:− Anosmia: total loss of sense of smell

− Dysosmia: distorted sense of smell

− Hyperosmia: increased sensitivity to smell

− Presbyosmia: loss of smell from normal aging

Anatomy and Physiology of the NoseAnatomy and Physiology of the Nose

• One of two primary entry points for oxygen

• Nasal septum: separation between the nostrils

• Turbinates: layers of bone within each nasal chamber

© Jones & Bartlett Learning

Anatomy and Physiology of the NoseAnatomy and Physiology of the Nose

• Frontal sinuses are above the nose.

• Paranasal sinuses− Cavities within

several bones associated with the nose

Patient AssessmentPatient Assessment

• Look for environmental clues.

• Ensure scene safety.

• Assess airway and breathing.

• Determine level of distress.

Patient AssessmentPatient Assessment

• Insert an airway adjunct as needed.− Do not insert a nasopharyngeal airway or

attempt nasotracheal intubation with:• Suspected nasal fractures

• CSF or blood leakage from the nose

− Inquire about history of nose conditions.

EpistaxisEpistaxis

• Nosebleed − Anterior

• Bleed fairly slowly

• Self-limiting and resolve quickly

− Posterior• More severe

• Often cause blood to drain into the throat, causing nausea and vomiting

EpistaxisEpistaxis

• Assessment and management:− Place a nontrauma

patient in a sitting position, and pinch nostrils together.

− Direct the patient not to sniff or blow his or her nose.

Foreign BodyForeign Body

• Most likely to be seen in pediatric patients

• Pressure in the nasal passage can cause:− Tissue necrosis

− Inflammation

− Swelling

Foreign BodyForeign Body

• Assessment and management− Determine life threats.

− Any persistent, foul-smelling, purulent discharge should lead to suspicion.• Let discharge drain.

− Transport the patient in a position of comfort.

RhinitisRhinitis

• A nasal disorder that is most common during childhood and adolescence − Generally caused by allergens

RhinitisRhinitis

• Assessment and treatment− Signs and symptoms may include:

• Nasal congestion

• Itchy runny nose and eyes

• Postnasal drip

− Keep the patient in the Fowler position.

SinusitisSinusitis

• Patients experience thick nasal discharge, sinus and facial pressure, headache, and fever.

• Infection occurs when an obstruction or growth blocks the paranasal sinus.

SinusitisSinusitis

• Assessment and management− Condition can be chronic, acute, or recurrent

− Treatment: reduce inflammation and drain sinuses.

− Complications occur when the infection moves into the brain or bone.

The ThroatThe Throat

• Disorders of the pharynx and larynx may include inflammation, infections, or abnormal growths.

The ThroatThe Throat

• Esophageal disorders can affect the throat.

• Esophageal reflux: valve only partially closes or opens too much− Symptoms include:

• Burning sensation in the chest

• Indigestion

• Change in voice tone

Anatomy and Physiology of the ThroatAnatomy and Physiology of the Throat

• 32 teeth distributed about the maxillary and mandibular arches− Each side of the arch form 4 quadrants

• One central incisor

• One lateral incisor

• One canine

• Two premolars

• Three molars

Anatomy and Physiology of the ThroatAnatomy and Physiology of the Throat

• The top portion of the tooth is the crown.− The pulp cavity fills the center of the tooth.

− Dentin forms the principal mass of the tooth.

• Alveoli are the bony sockets for the teeth.− Alveolar ridges: ridges between the teeth that

are covered by gums

Anatomy and Physiology of the ThroatAnatomy and Physiology of the Throat

The MouthThe Mouth

• Digestion begins with mastication.

• Tongue: the primary organ of taste− Attached at

mandible and hyoid bone

− Covered by a mucous membrane

The MouthThe Mouth

• Nerves:− Hypoglossal

• Provides motor function to the tongue

− Glossopharyngeal• Provides taste

sensation

− Trigeminal• Provides motor

innervation to the muscles of mastication

− Facial• Supplies motor

activity of facial expression

• Provides taste sensation

• Provides cutaneous sensations to the tongue and palate

The NeckThe Neck

• Anterior part of the neck include:− Thyroid and cricoid

cartilage

− Trachea

− Muscles and nerves

− Major blood vessels

The NeckThe Neck

• Other structures:− Vagus nerves

− Thoracic duct

− Esophagus

− Thyroid and parathyroid glands

− Lower cranial nerves

− Brachial plexus

− Soft tissue and fascia

− Various muscles

Patient AssessmentPatient Assessment

• Swallowing abnormalities require a position to allow drainage.

• Assessments should consider epiglottitis if: − Sore throat

− Drooling

− Head that is hung forward

Dentalgia and Dental AbscessDentalgia and Dental Abscess

• Dentalgia: toothache

• Dental abscess− Occurs when a

bacteria growth spreads into the gums, facial tissue, bones, and/or neck

© Dr. P. Marazzi/Photo Researchers, Inc.

Dentalgia and Dental AbscessDentalgia and Dental Abscess

• Assessment and management− Infection may become systemic.

− An abscess in the throat, neck, or under the tongue can affect the ability to breathe.

− Prehospital treatment is aimed at relieving symptoms.

Diseases of Oral Soft TissueDiseases of Oral Soft Tissue

• Can be the root cause to other health problems

• Include:− Cold sores

− Canker sores

− Thrush

− Leukoplakia

− Gingivitis

− Bad breath

Diseases of Oral Soft TissueDiseases of Oral Soft Tissue

• Assessment and management− Rule out urticaria and allergic reactions.

Oral Candidiasis (Thrush)Oral Candidiasis (Thrush)

• Candida albicans accumulates on the lining of the mouth.

• Patient will have creamy white lesions.− May be painful and

may bleed

© Biophoto Associates/Photo Researchers, Inc.

Oral Candidiasis (Thrush)Oral Candidiasis (Thrush)

• Assessment and management− Most likely to be found in:

• Babies

• Patients with compromised immune systems

• Patients who wear dentures

• Patients who use inhaled corticosteroids

Oral Candidiasis (Thrush)Oral Candidiasis (Thrush)

• Assessment and management (cont’d)− Additional symptoms may include:

• Cracking and redness at the corners of the mouth

• A “cottony” feeling in the mouth

• Sensation of food stuck in the throat

Oral Candidiasis (Thrush)Oral Candidiasis (Thrush)

• Assessment and management (cont’d)− Patients at increased risk:

• HIV/AIDS

• Cancer

• Diabetes

• Vaginal yeast infections

− Treat higher priorities.

− Make the patient comfortable.

Ludwig AnginaLudwig Angina

• Cellulitis caused by bacteria from an infected tooth root or mouth injury

• Physical exam may show redness and swelling of the neck or under the chin.

Ludwig AnginaLudwig Angina

• Assessment and management− Symptoms may include:

• Difficulty breathing

• Neck pain and swelling

• Altered speech sounds

Ludwig AnginaLudwig Angina

• Assessment and management (cont’d)− Prehospital treatment requires aggressive

management of the airway in severe cases.

− Contact medical control physician early on.

− Attend to basic ABCs.

Foreign Body in the ThroatForeign Body in the Throat

• Assessment and management− Keep the patient calm.

− Transport in a position where if the object becomes dislodged, gravity will allow it to fall out.

EpiglottitisEpiglottitis

• Inflammation of the epiglottis− Blocks the trachea and obstructs the airway

− Often a result of the H. influenzae type b virus

EpiglottitisEpiglottitis

• Assessment and management− Symptoms may

include:• Fever

• Painful swallowing

• Stridor

− Signs may include:• Sick and anxious

• “Tripod” position or sniffing position

• Pallor or cyanosis

EpiglottitisEpiglottitis

• Assessment and management (cont’d)− Transport to an appropriate hospital.

• Minimize scene time.

• Do not agitate the patient.

• Do not attempt to look in the mouth.

• Alert receiving personnel.

LaryngitisLaryngitis

• Swelling and inflammation of the larynx

• Causes may include:− Pneumonia

− Irritants and chemicals

− Bronchitis

− Allergies

LaryngitisLaryngitis

• Assessment and management− Symptoms include:

• Fever

• Hoarseness

• Swollen lymph nodes or glands

− Have the patient follow up with a physician.

TracheitisTracheitis

• A bacterial infection of the trachea caused by Staphylococcus aureus− Frequently occurs in children following URI

− Trachea is easily blocked by swelling

− Can be life-threatening

TracheitisTracheitis

• Assessment and management− Symptoms:

• “Croup-like” cough

• Difficulty breathing

• High fever

− Signs:• Tripod positioning

• Intercostal retractions

TracheitisTracheitis

• Assessment and management (cont’d)− Minimize stress to the patient.

− Administer 100% oxygen.

− Use pulse oximetry.

− Monitor vital signs.

− Be prepared for difficult intubation.

− Transport promptly.

TonsillitisTonsillitis

• Swelling and inflammation of the tonsils

• Usually caused by viral infections− Can also be

caused by bacteria © Biophoto Associates/Photo Researchers, Inc.

TonsillitisTonsillitis

• Assessment and management − Symptoms:

• Swollen tonsils

• Sore throat

• Difficulty swallowing

− Signs:• White or yellow

coating or patches

• Fever

• Sore throat

PharyngitisPharyngitis

• Inflammation of the pharynx

• Often due to a rapid onset of sore throat − Without discomfort

or pain with swallowing

© BSIP/Photo Researchers, Inc.

PharyngitisPharyngitis

• Assessment and management− Symptoms may include:

• Discomfort or pain on swallowing

• Pharyngeal erythema

• Purulent patchy yellow, gray, or white exudate

• Ulcers on the soft palate

Peritonsillar AbscessPeritonsillar Abscess

• Collection of infected material around the tonsils

• Complication of tonsillitis

© Dr. P. Marazzi/Photo Researchers, Inc.

Peritonsillar AbscessPeritonsillar Abscess

• Assessment and management− Symptoms may include:

• Facial swelling

• Inability to swallow

• Tender glands of jaw and throat

Peritonsillar AbscessPeritonsillar Abscess

• Assessment and management (cont’d)− Treatment involves antibiotics and draining the

abscess.

− Transport patient to the hospital.

Temporomandibular Joint Disorders

Temporomandibular Joint Disorders

• Causes include:− Arthritis damage to

the joint’s cartilage

− Jaw injury

− Jaw muscle fatigue from grinding or clenching of the teeth

Temporomandibular Joint Disorders

Temporomandibular Joint Disorders

• Assessment and management− Symptoms may include:

• Jaw pain

• Difficulty chewing

• Locking of the joint

SummarySummary

• Paramedics may encounter emergencies related to disorders of the eye, ear, nose, or throat (EENT) or may discover these disorders while assessing an unrelated emergency.

• Assess the eye for pain, tenderness, swelling, abnormal or loss of movement, sensation changes, circulatory changes, deformity, and visual changes.

SummarySummary

• Early transport to an appropriate facility can improve outcomes.

• Provide emotional care to patients with eye conditions.

• Flush burns to the eye. Never use chemical antidotes when treating burn injuries to the eye.

SummarySummary

• Specific conditions of the eye include conjunctivitis, corneal abrasion, foreign body, inflammation, glaucoma, hyphema, iritis, papilledema, retinal detachment and defect, and cellulitis of the orbit.

• The ear is the primary structure for hearing and balance.

SummarySummary

• Adequate assessment of the external ear canal and middle ear cannot be performed in the field.

• Specific conditions of the ear include foreign body, impacted cerumen, labyrinthitis, Meniere disease, otitis, and perforated tympanic membrane.

SummarySummary

• The nose is a vascular structure and contains nasal mucosa that is a short route to the brain.

• Never insert a nasopharyngeal airway or attempt nasotracheal intubation in any patient with suspected nasal fractures or in patients with CSF or blood leakage from the nose.

SummarySummary

• Specific problems related to the nose include epistaxis, foreign body, rhinitis, and sinusitis.

• Disorders of the throat may represent acute inflammation and infections, chronic inflammation, or abnormal growths.

SummarySummary

• When assessing a patient with a throat complaint, note whether the patient is able to swallow.

• Specific disorders include dentalgia, dental abscess, Ludwig angina, foreign body, epiglottitis, laryngitis, tracheitis, oral candidiasis, peritonsillar abscess, pharyngitis/tonsillitis, and temporomandibular joint disorders.

CreditsCredits

• Chapter opener: © Biophoto Associates/Photo Researchers, Inc.

• Backgrounds: Green—Jones & Bartlett Learning; Purple—Courtesy of Rhonda Beck; Red—© Margo Harrison/ShutterStock, Inc.; Orange—© Keith Brofsky/Photodisc/Getty Images.

• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.