Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks
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Nov 19, 2013 Dr. Maria Ivankovic, an emergency physician and lecturer at the University of Toronto, teams up with Dr. Leeor Sommer, an expert in ENT skills and hands-on workshops. They dive into the intricacies of managing epistaxis, offering a four-step approach and tips for foreign body removal. Key discussions include the urgent treatment of sudden sensorineural hearing loss and the critical signs of epiglottitis. They also explain the nuances of diagnosing and managing angioedema, stressing the importance of airway assessment and effective treatment strategies.
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Stepwise Approach To Anterior Epistaxis
- Visualize, anesthetize, cauterize, then tamponize when managing anterior epistaxis.
- Use oxymetazoline plus topical lidocaine, wait 10 minutes, then cauterize peripherally and dry before applying silver nitrate.
Best Topical For Nosebleeds
- Use oxymetazoline (Dristan) with lidocaine as first-line topical vasoconstrictor and anesthetic.
- Avoid phenylephrine; 4% cocaine is effective but less available and riskier systemically.
Safe Silver Nitrate Technique
- Apply silver nitrate for 5–15 seconds only on one side and just peripheral to the bleeding site.
- Dry the mucosa, avoid bilateral cautery, and moisturize the area afterward to prevent septal necrosis.