- Auricular Hematoma Evacuation
- Cerumen Impaction Removal
- Epistaxis Management
- Nasal Foreign Body Removal
- Peritonsillar Abscess Drainage
Auricular Hematoma Evacuation
- Background
- Complication from direct trauma to the anterior auricle; common in wrestlers. If left untreated, it may result in an auricular deformity known as “cauliflower ear”
- Indications
- Traumatic injury causing anterior auricular swelling
- Contraindications
- Hematomas older than 7 days (should be referred to a specialist)
- Complications
- Infection, scar formation, reaccumulation of hematoma, chondritis
*Deep Dive: Auricular Hematoma Management (REBEL EM)
Cerumen Impaction Removal
- Background
- Cerumen impaction is caused by a buildup of wax within the ear canal and can lead to pain, tinnitus, dizziness, or decreased hearing. Removal can be achieved by manual removal, irrigation, or cerumenolytic agents
- Indications
- Cerumen buildup with symptoms (pain, tinnitus, decreased hearing, etc.), inability to view the full tympanic membrane for diagnostic purposes.
- Contraindications
- Uncooperative patient, inability to visualize ear canal. Irrigation is contraindicated in the presence or history of perforated TM.
- Complications
- Short-term vertigo, lacerations to ear canal skin, worsening tinnitus.
*Deep Dive: Cures for Cerumen Impaction (The Procedural Pause)
Epistaxis Management
- Background
- Epistaxis is acute hemorrhage from the nostril, nasal cavity, or nasopharynx. 90% of bleeds occur from the anterior septum, with 10% in the posterior region. Management techniques include nasal packing vs commercial balloon tamponade devices
- Indications
- Uncontrolled bleeding despite conservative management.
- Contraindications
- Hemodynamically unstable; uncontrolled airway
- Complications
- Inadequate bleeding control, infection, sinusitis
*Deep Dive: The Emergency Department Management of Posterior Epistaxis (emDocs)
Nasal Foreign Body Removal
- Background
- Typically occur in children; common foreign bodies include marbles, beans, nuts, beads, magnets, stones, etc. There are several removal techniques (Bulb syringe, manual removal with forceps, “Parent’s Kiss”, balloon catheter)
- Indications
- Known or suspected nasal foreign body (often present with unilateral purulent/bloody nasal discharge or unilateral sinusitis)
- Contraindications
- Inability to see foreign body, significant inflammation/edema, several failed attempts at removal.
- Complications
- Nasal mucosa injury, aspiration of foreign body, barotrauma (from “parent’s kiss” or BVM technique)
*Deep Dive: 20 Ways of Removing a Nasal Foreign Body in the Emergency Department (OAT)
Peritonsillar Abscess Drainage
- Background
- Peritonsillar abscesses are a complication of tonsillitis; it is the most common deep infection of the head and neck. Drainage is needed to prevent deep neck space infections, sepsis, and carotid artery erosion.
- Indications
- Cases of suspected peritonsillar abscess
- Contraindications
- Vascular malformations, malignancy, uncooperative patients.
- Complications
- Aspiration of abscess contents, bleeding.
*Deep Dive: Trick: Peritonsillar abscess drainage 3.0 (ALiEM)
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