Transcript Chapter 19: Diseases of the Eyes, Ears, Nose, and Throat

Chapter 19
Diseases of the Eyes,
Ears, Nose, and Throat
National 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 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
Introduction
• 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 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 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 Eye
Anatomy 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 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 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 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 Eye
• Lacrimal apparatus
− Secretes and
drains tears from
the eye
− Tears moisten the
conjunctivae.
Patient Assessment
• Ensure scene safety.
• Cover both eyes.
• Keep your patient
calm.
• Consider pain
management.
• Form a general
impression.
• Cardiac monitoring is
recommended.
• Assess airway and
breathing.
Patient Assessment
• Obtain chief complaint and history.
− OPQRST
− Diabetes is the leading cause of new cases of
blindness in adults.
• Diabetic retinopathy
Patient 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 Assessment
• Assess for:
− Pain/tenderness
− Swelling
− Abnormal or loss
of movement
− Circulatory
changes
− Deformity
− Visual changes
− Sensation
changes
− Airway
compromise
Patient Assessment
• Assess structures:
− Orbital rim
• Ecchymosis,
swelling,
lacerations, and
tenderness
− Eyelids
• Ecchymosis,
swelling,
lacerations, or any
abnormalities
− Corneas
• Foreign bodies
Patient Assessment
• Assess structures:
− Conjunctivae
• Redness, pus,
inflammation, and
foreign bodies
− Globes
• Redness,
pigmentation, and
lacerations
− Pupils
• Size, shape,
equality, and
reaction to light
Patient 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 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 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 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 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 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 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 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 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 Adnexa
Burns of the Eye and Adnexa
Burns 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 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 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.
Conjunctivitis
• 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
Conjunctivitis
• 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 Abrasion
• Painful
• Due to superficial trauma to the cornea
• If discomfort does not resolve, patient
should be seen in the emergency
department.
Corneal 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 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 Body
• Can cause significant pain
• Commonly caused by machines such as:
− Grinders
− Sanders
− Nailers
− Weed whackers
Foreign 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 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 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)
− Chalazion: swollen
bump or pustule on
the external eyelid
− Hordeolum (stye):
red tender lump in
the eyelid or the lid
margin
© Francoise Sauze/Photo Researchers, Inc.
• Oil glands and oil
ducts may become
blocked, causing:
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.
Glaucoma
• Group of conditions that lead to increased
intraocular pressure
• Usually treated with eye drops to reduce
ocular pressures
Glaucoma
• 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.
Hyphema
• Bleeding into the
anterior chamber
of the eye
− Obscures vision
− Blood clotting is a
concern.
• Can cause a rise in
intraocular
pressure
Hyphema
• 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.
Hyphema
• Assessment and management (cont’d)
− If no contraindications, transport upright.
• Other medications with antiplatelet effects should be
avoided.
− An anxiolytic may facilitate transport.
Iritis
• 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.
Iritis
• 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.
Papilledema
• 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
Papilledema
• 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
Papilledema
• 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 Defect
• Potential result of blunt eye trauma
• Assessment and management:
− Generally painless
− Produces:
• Flashing lights
• Specks
• “Floaters”
− Requires immediate medical attention
Cellulitis 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 Orbit
• Assessment and management
− Treatment includes antibiotics.
− Prehospital management includes:
• Ruling out life threats
• Obtaining a thorough history
• Transporting to the appropriate care
The 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 Ear
• Divided into three anatomic parts
Anatomy 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 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 Assessment
• Ensure ABCs and manage life threats.
• Take a complete history.
• Observe ears for:
−
−
−
−
Drainage
Excess cerumen
Inflammation
Swelling
Patient Assessment
• Have patient rate his
or her pain.
• Ask about:
− Changes in hearing
− Tinnitus
− Dizziness
• Inspect for:
−
−
−
−
Wounds
Swelling
Drainage
Mastoid process
• Transport.
Foreign 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 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 Cerumen
• Risk factors include:
− Abnormal ear canal shape
− Diseases that cause increased cerumen
− Improper use of cotton swabs
Impacted Cerumen
• Assessment and management
− Symptoms may include:
• Pressure or fullness in the ears
• Ringing in the ears
• Loss of hearing
Impacted Cerumen
• Assessment and management (cont’d)
− Prehospital treatment includes:
• Thorough history
• Visual inspection of the ear
Labyrinthitis
• 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
Labyrinthitis
• 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 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 Disease
• Assessment and management
− Prehospital care includes an antiemetic.
− Physician may treat with diuretics and an
antiemetic.
Otitis 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 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
• Ruptured eardrum
• Results from:
− Foreign bodies in the ear
− Pressure-related injuries
− Diving-related injuries
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 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 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 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 Nose
• Frontal sinuses are
above the nose.
• Paranasal sinuses
− Cavities within
several bones
associated with the
nose
Patient Assessment
• Look for environmental clues.
• Ensure scene safety.
• Assess airway and breathing.
• Determine level of distress.
Patient 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.
Epistaxis
• 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
Epistaxis
• 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 Body
• Most likely to be seen in pediatric patients
• Pressure in the nasal passage can cause:
− Tissue necrosis
− Inflammation
− Swelling
Foreign 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.
Rhinitis
• A nasal disorder that is most common
during childhood and adolescence
− Generally caused by allergens
Rhinitis
• Assessment and treatment
− Signs and symptoms may include:
• Nasal congestion
• Itchy runny nose and eyes
• Postnasal drip
− Keep the patient in the Fowler position.
Sinusitis
• Patients experience thick nasal discharge,
sinus and facial pressure, headache, and
fever.
• Infection occurs when an obstruction or
growth blocks the paranasal sinus.
Sinusitis
• 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 Throat
• Disorders of the pharynx and larynx may
include inflammation, infections, or
abnormal growths.
The 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 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 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 Throat
The Mouth
• Digestion begins
with mastication.
• Tongue: the primary
organ of taste
− Attached at
mandible and hyoid
bone
− Covered by a
mucous membrane
The 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 Neck
• Anterior part of the
neck include:
− Thyroid and cricoid
cartilage
− Trachea
− Muscles and nerves
− Major blood vessels
The Neck
• Other structures:
− Vagus nerves
− Thoracic duct
− Esophagus
− Thyroid and
parathyroid glands
− Lower cranial
nerves
− Brachial plexus
− Soft tissue and
fascia
− Various muscles
Patient 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 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 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 Tissue
• Can be the root
cause to other
health problems
• Include:
− Cold sores
− Canker sores
− Thrush
− Leukoplakia
− Gingivitis
− Bad breath
Diseases of Oral Soft Tissue
• Assessment and management
− Rule out urticaria and allergic reactions.
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)
• 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)
• 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)
• Assessment and management (cont’d)
− Patients at increased risk:
• HIV/AIDS
• Cancer
• Diabetes
• Vaginal yeast infections
− Treat higher priorities.
− Make the patient comfortable.
Ludwig 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 Angina
• Assessment and management
− Symptoms may include:
• Difficulty breathing
• Neck pain and swelling
• Altered speech sounds
Ludwig 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 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.
Epiglottitis
• Inflammation of the epiglottis
− Blocks the trachea and obstructs the airway
− Often a result of the H. influenzae type b virus
Epiglottitis
• Assessment and
management
− Symptoms may
include:
• Fever
• Painful swallowing
• Stridor
− Signs may
include:
• Sick and anxious
• “Tripod” position
or sniffing position
• Pallor or cyanosis
Epiglottitis
• 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.
Laryngitis
• Swelling and inflammation of the larynx
• Causes may include:
− Pneumonia
− Irritants and chemicals
− Bronchitis
− Allergies
Laryngitis
• Assessment and management
− Symptoms include:
• Fever
• Hoarseness
• Swollen lymph nodes or glands
− Have the patient follow up with a physician.
Tracheitis
• 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
Tracheitis
• Assessment and
management
− Symptoms:
• “Croup-like”
cough
• Difficulty breathing
• High fever
− Signs:
• Tripod positioning
• Intercostal
retractions
Tracheitis
• 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.
Tonsillitis
• Swelling and
inflammation of the
tonsils
• Usually caused by
viral infections
− Can also be
caused by bacteria
© Biophoto Associates/Photo Researchers, Inc.
Tonsillitis
• Assessment and
management
− Symptoms:
• Swollen tonsils
• Sore throat
• Difficulty
swallowing
− Signs:
• White or yellow
coating or patches
• Fever
• Sore throat
Pharyngitis
• Inflammation of the
pharynx
• Often due to a
rapid onset of sore
throat
− Without discomfort
or pain with
swallowing
© BSIP/Photo Researchers, Inc.
Pharyngitis
• 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 Abscess
• Collection of
infected material
around the tonsils
• Complication of
tonsillitis
© Dr. P. Marazzi/Photo Researchers, Inc.
Peritonsillar Abscess
• Assessment and management
− Symptoms may include:
• Facial swelling
• Inability to swallow
• Tender glands of jaw and throat
Peritonsillar Abscess
• Assessment and management (cont’d)
− Treatment involves antibiotics and draining the
abscess.
− Transport patient to the hospital.
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
• Assessment and management
− Symptoms may include:
• Jaw pain
• Difficulty chewing
• Locking of the joint
Summary
• 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.
Summary
• 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.
Summary
• 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.
Summary
• 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.
Summary
• 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.
Summary
• 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.
Summary
• 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.
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• Backgrounds: Green—Jones & Bartlett Learning;
Purple—Courtesy of Rhonda Beck; Red—© Margo
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• 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.