HEENT


Dental Pain

Rapid Review

  • 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

Pearls

Video Credit: Jacobi/Montefiore Emergency Medicine


Hemoptysis

Rapid Review

  • 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

Pearls

Video Credit: Strong Medicine


Red Eye

Rapid Review

  • 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. (watery vs 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 sign
      • 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

Pearls

Video Credit: Strong Medicine


Sore Throat

Rapid Review

  • 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

Pearls

Video Credit: Valley ENT

Brandon Simpson, PA-C
Latest posts by Brandon Simpson, PA-C (see all)
  • Blog - 25 Feb 2021