1. Emergency situation in ENT
Azita Gebauerová
3rd Medical Faculty of Charles University
Prague

2. Dyspnoe
Acute laryngitis
Subglottic laryngitis
Acute epiglotitis- supraglottic laryngitis
Allergic oedema of larynx
Laryngospasmus
Tumors
Trauma
Burns
Aspiration
Foreign bodies
Bleeding
Ear
Nose
Larynx + trachea
Esophagus
Sudden loss of hearing
Acute vertigo
Vestibular
M. Menieri

3. Bleeding Epistaxis From nasopharynx From vessels of rinobase
From larynx
Hemoptysis
Hemoptoe
Hematemesis

4. Epistaxis
Downer part- a. sphenopalatina-a. maxillaris- a. carotis int.
Upper part- a. ethmoidalis ant. et post.- a. opthalmica- a. carotis ext.
Both in anterior part of septum- L. Kiesselbachi %

5. Causes Causes: Arterial (intermitent, sudden, intenzive)
Venous(continual, longer lasting, less intenzive)
Local (esencial, polyp, TU, microtrauma, atrofic inflammation, injuries)
Systemic(hypertension, coagulopathy, liver and kidney diseases, m. Rendu-Osler)

6. Treatment
Localisation- per exclusionem- BP, anamnesis (physician) rhinoscopy,endoscopy (specialist)
- laboratory tests
Therapy-first aid: head on knees, cold bandage, griping of nasal alae
-local: anemisation, elektrocoagulation, chemokoagulation, anterior packing, posterior packing
-vascular ligation: till a. car. ext.
-selective arterial embolisation of supplying arteries radiodg. departement
-general terapy: haemostyptics, blood transfusion,trombocytes

7. Dyspnoea Dif.dg. of respiratory dyspnoea
Upper and lower part of airways
- Subglottic laryngitis
- Supraglottic laryngitis (epiglottitis)
-Laryngotracheitis crustosa

8. Stages of laryngeal dyspnoea
Compensatory
prolongation of breath, insp.stridor, saturation of O2..
Decompensatory
accelerative breathing, sweating, paleness, stridor insp. + exspir., anxiety, ...
Asfyxy
paradoxical pacification, cyanotic color, attenuation of breathing

9. Laryngitis subglottica
- Viral origin (adenovirus, myxovirus, influenza and parainluenza) allergy, GER… -mostly appearance : 1-5y, wet,cold, windy weather, in the night -Symptoms: inspiratory stridor, dry coughing attacks, hoarseness -Therapy: steroids, Promethazin, atb prevention superinfection, wet air

10. Laryngitis supraglottica (epiglottitis)
-bacterial (H. influenzae, Str. heamolyticus) -all groups, max. to 10 y -symptoms: sorethroat, odynofagy, fever, inspiratory stridor, salivation, problems with swallowing -therapy:hospitalization!, ICU-monitoring of vital functions ATB, steroids 1000mg/day, antihistaminics, intubation, hydratation + minerals

11. Laryngotracheobronchitis pseudomembranosa et crustosa
-virulent infection-damage of epitelium-fibrin membranes-superinfection-incrustation-obturation -all ages groups -Symptoms: pain in throat behind sternum, painful coughing with blood, dyspnoea in inspirium, released incrustations -Therapy:ATB, inhalation, mucolytics and expectorans, O2, tracheobronchoscopy

12. Laryngospasm
Aetiology:irritation by investigation, from aspiration, diving in cold water, irritation of n.V or n.olfactorius, GER
Symptoms: sudden inspiratory stridor, labouring breathing with auxiliary muscles, indurannce of jugulum and chesty flexible walls, clonic spasm, unconsciousness
Therapy: irritation of the other parts of body, protrusion of tongue, free airways, sedation

13. Laryngeal injuries
Opened: cutted wounds of neck-accidents-danger of blood aspiration
Symptoms: dyspnoea, hoarsness, haemoptysis, foaming blood, emfysema, shock
Therapy: surgical revision of the wound, treatment of the bleeding, tracheostomy, O2, steroids, ATB
Closed: dislocated fractures of cartilages, haematoma, rupture of mucose,iatrogenic invasive procedures
Symptoms: painfull speaking, haemoptysis, stridor
Dg: laryngoscopy, CT
Therapy: observation, tracheostomy, surgical reconstruction,
steroids, ATB,inhalations

14. Laryngeal oedema Dyspnoea, dysfagia: depends on extention
Acute-allergic
Progressive-postradiation
Patogenesis: toxins of insects, allergic reaction (food alergens)-Quincke angioneurotic oedema, lymfostasis (postiradiation), injury, burning by chemicals
Dg-laryngoscopy
Th-ICU, steroids,antihistaminics, nebulisation

15. Foreign bodies in airways
Mostly in childhood-toys, beans, peanuts(risk of bronchitis)
To the right bronchus and lung
Symptoms:irritative cough with stridor,danger of suffocation, auscultation, chest X-ray-collapsed or overinflated lung, marks of inflammation
Therapy: tracheobronchoscopy with suction tubes, ATB
Chronic CT- children-constant cough with expectoration, bronchopneumony, bronchiectasy, abscess-explorative bronchoscopy

16. Esophageal injury
PERFORATING-penetration wounds of the neck, sharp foreing bodies, endoscopic manipulation, dilatation of strictures
Sy: retrosternal pain, dysphagia, saliva in wound, emfysema- !!!mediastinitis
Dg: sy, X-ray contrast with absorbable fluid, endoscopy
Therapy: ATB, esofagoscopy, surgical revision-thoracotomy event. Lateral cervikotomy
NO PERFORATING-Corrosive- burning with acid, alkalies, chemicals, suicide
Symptoms: anamnesis, sharp pain, salivation, dysphagia, oedema, mucosal erytema , perforation-peritonitis
Therapy:first aid- neutralization-water, milk, citric acid, antacid, intubation or tracheotomy, NG, steroids, ATB
!!! stenosis-dilatation, reconstruction with graft

17. Foreign body in oesophagus
Every age
-fish bone, cervical part of esophagus-bones, coins, stone( esofagoscopy under GA), prisoners
Symptoms: anamnesis, dysfagia, salivation
Dg:X-ray in two ways, wisp of cotton with contrast
Suspicion for perforation- sine baryum
Therapy: rigid esofagoscopy , ATB, NG tube

18. Treatment of dyspnoea Decompensative- due to conditions In hospital
1.intubation tracheotomy

19. Coniotomy
Coniotomy
Coniopunction