HEENT

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

Deep Dive

• Common Dental Emergencies (AAFP)

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

Deep Dive

• Hemoptysis (emDocs)

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

Deep Dive

• The Red Eye (Core EM)

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

Deep Dive

• Evidence-Based Evaluation and Management of Patients With Pharyngitis In The Emergency Department (EB Medicine)