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ENT

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EM@3AM: Retropharyngeal Abscess

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A 3-year-old male is brought in by his mother for severe throat pain and lethargy. She notes that he is playing less, refusing to eat, and preferring to lie supine. Review of systems is remarkable for a recent small fall with his toothbrush in his mouth. Triage vital signs include BP 91/49, HR 141, T 103.1 temporal, RR 25, SpO2 96% on room air. He appears toxic and is lying supine. The oropharyngeal exam is normal, but the patient has prominent generalized cervical lymphadenopathy, torticollis, and a painful tracheal rock. The patient has no voice changes but does not want to extend his neck. What’s the most likely diagnosis?

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EM@3AM: Lemierre’s syndrome

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A 23-year-old male presents for severe throat pain and cough. He states that his neck hurts, with left sided redness and pain. Vital signs include BP 91/49, HR 130, T 102.2 temporal, RR 25, SpO2 91% on room air. He appears toxic. The ENT exam reveals a midline uvula; soft mouth floor; prominent generalized cervical, submandibular, and submental swelling with corresponding lymphadenopathy; but no voice changes or difficulty tolerating secretions. His neck is red and tender, with mild swelling overlying the left side of neck and a painful tracheal rock. What is the most likely diagnosis?

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Ultrasound G.E.L. – POCUS for Peritonsillar Abscess

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Do you use ultrasound for suspected peritonsillar abscess (PTA)? Some of us probably do, some don’t – but what does the evidence say?? Does it help the clinician? and (dare we ask) does it help the patient? This paper is potentially the best data we currently have on the topic. Mike and special guest Kim Fender dive straight into the purulence of this fluctuant topic.

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EM@3AM: Laryngospasm

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An 8-year-old male presents after falling onto an outstretched hand. He has an obvious dinner fork deformity to the right forearm. X-ray confirms a fracture of the distal radius and ulna. You prepare for procedural sedation with ketamine while you reduce and splint the fracture. You run through the pre-sedation assessment and exam, then gather all medications and airway supplies. Once the ketamine is pushed you hear a high-pitched stridor and see the patient’s chest rise and fall irregularly as his oxygen saturation drops. What is the diagnosis and management?

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EM@3AM: Beverage Tab Ingestion

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A 12-year-old boy with no past medical history accidentally ingested a soda can tab 2.5 hours prior to arrival. He is asymptomatic at present, feels well, and is able to tolerate secretions without difficulty. On exam, the patient is alert, acyanotic, and non-stridulous. Breath sounds are clear to auscultation bilaterally, and his abdomen is nontender. What evaluation is necessary, and what is the appropriate management?

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