HEENT

  • Dental Pain
  • Hemoptysis
  • Red Eye
  • Sore Throat

Dental Pain

  • Differentials 
    • Atraumatic
      • Odontogenic
        • Pulpitis
        • Pericoronitis
        • Periradicular periodontitis
        • Post-extraction pain
        • Alveolar Osteitis
      • Periodontal
        • Periapical abscess
        • Periodontal abscess
        • Acute necrotizing ulcerative
        • Gingivitis
        • Ludwig’s Angina
    • Traumatic
      • Fracture
      • Subluxation
      • Avulsion
  • History
    • Trauma?
      • Consider fractures,subluxation, avulsion
    • Hot/cold sensitivity?
      • Suggests exposed dentin
    • Recent dental procedures?
      • Consider dry socket, incomplete extractions, abscess
    • Fever/chills?
      • Suggests infectious causes
  • Physical Exam
    • Head trauma?
      • Consider injuries to several teeth and/or other facial structures
    • Neck swelling?
      • Consider ludwig’s angina
    • Gingival swelling?
      • Consider periapical abscess
  • Work-Up
    • Imaging
      • CT Maxillofacial w/ IV contrast
Video Credit: Jacobi/Montefiore Emergency Medicine

*Deep Dive: Common Dental Emergencies (AAFP)

Hemoptysis

  • Differentials
    • Airway Disease
      • Bronchitis/Bronchiectasis
      • Neoplasm
      • Trauma
      • Foreign Body
    • Infectious
      • Tuberculosis
      • Pneumonia
      • Fungal Infection
    • Vascular Disease
      • Pulmonary Embolism
      • AV Malformation
      • Pulmonary Hypertension
      • Vasculitis
    • Other
      • Coagulopathy
      • Valvular Heart Disease
      • Cocaine
  • History
    • Hemoptysis or hematemesis?
      • Differentiate between pulmonary and GI pathology
    • Scant, frank, or massive?
      • Differentials vary based on amount of blood
    • Immunosuppression?
      • Consider tuberculosis
    • Sedentary?
      • Consider pulmonary embolism
    • Smoking history?
      • Consider lung cancer or chronic bronchitis
  • Physical Exam
    • Asymmetrical lung sounds?
      • May help identify source of bleeding
    • HEENT exam
      • Identify other potential sources of bleeding
    • Lymphadenopathy
      • Suggests malignancy as source
    • Signs of DVT?
      • Suggests pulmonary embolism
  • Work-up
    • Labs
      • CBC, aPTT, INR
    • Imaging
      • CXR
      • Chest CT
Video Credit: Strong Medicine

*Deep Dive: Hemoptysis (emDocs)

Red Eye

  • Differentials 
    • Painful
      • Ruptured globe
      • Corneal ulcer
      • Corneal abrasion
      • Acute angle closure glaucoma
    • Painless
      • Conjunctivitis
      • Subjunctival hemorrhage
      • Hyphema
    • Extra-ocular
      • Blepharitis
      • Hordeolm
      • Orbital/periorbital cellulitis
      • Cavernous sinus thrombosis
      • Cluster headache
  • History
    • Foreign Body sensation?
      • Consider corneal foreign body/abrasion
    • Sick Contacts?
      • Consider conjunctivitis
    • Discharge? If so, watery or purulent?
      • Consider infectious causes
    • Exposure to metal or wood working?
      • Consider foreign body
  • Physical Exam
    • External rash
      • Suggests orbital or periorbital cellulitis
    • Painful EOM
      • Suggests scleritis or cellulitis
    • Elevated Intraocular pressure
      • Consider glaucoma
    • Discharge
      • Consider conjunctivitis
    • Hutchinson sig908
      • Consider herpes ophthalmicus
  • Work-Up
    • Fluorescein
      • If suspect corneal ulcer or abrasion
    • Tonometry
      • If suspect increased intraocular pressure
    • CT Orbit
      • If suspect ruptured globe or corneal laceration
Video Credit: Strong Medicine

*Deep Dive: The Red Eye (Core EM)

Sore Throat

  • Differentials 
    • Infectious
      • Peritonsillar abscess/Cellulitis
      • Retropharyngeal/Parapharyngeal abscess
      • Epiglottitis
      • Strep pharyngitis
      • Mononucleosis
      • Viral pharyngitis
      • Ludwig’s angina
      • Diphtheria
    • Noninfectious
      • Caustic ingestion
      • Foreign body
      • Acute coronary syndrome
      • Lymphoma
      • Oropharyngeal tumor
  • History
    • Voice changes?
      • Consider peritonsillar abscess 
    • Drooling?
      • Consider deep space neck infection
    • Recent weight changes/fatigue?
      • Consider cancer
    • Sexual history?
      • Consider gonococcal infection
    • Sick contacts?
      • Consider strep pharyngitis, viral pharyngitis, or mononucleosis
  • Physical Exam
    • Respiratory distress?
      • Consider need for airway intervention
    • Uvula deviation?
      • Suggests peritonsillar abscess
    • Abnormal lung sounds?
      • Consider lower respiratory tract infection
    • Stridor, drooling, sniffing position?
      • Consider airway obstruction
    • Rashes or lesions?
      • Consider strep or diphtheria
  • Work-Up
    • Labs
      • CBC, BMP
      • Rapid strep test (if Centor score = 3)
      • Throat culture (if rapid strep negative)
      • Gonorrhea/chlamydia (if recurrent; not improving)
    • Imaging
      • Lateral neck X-ray
      • CT neck w/ IV contrast
Video Credit: Valley ENT

*Deep Dive: Evidence-Based Evaluation and Management of Patients With Pharyngitis In The Emergency Department (EB Medicine)

Brandon Simpson, PA-C
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