MyCpdZw - Protocols Details

FOREIGN BODIES IN ENT & GIT

Patients with foreign bodies (FB)in the gastrointestinal (GI) tract commonly present to the emergency department (ED).

Diagnosis

Pharyngeal:

Bones are the most common Foreign Body.

Get patient to localize the Foreign Body & remove with Magill’s forceps after co-phenylcaine/

xylocaine anaesthetic.

Oesophageal:

Food boluses common in adults, coins in kids.

FB’s tend to stick at level of cricopharyngeus (C6), Thoracic inlet (T1), Aortic arch (T4), Tracheal

bifurcation (T5) & gastro-oesophageal sphincter (T10). After that they tend to continue their

passage!

Objects over 5cm long or 2cm diameter rarely pass through the pylorus.

Presents with airway compromise, stridor, coughing, choking, drooling, neck or throat pain, haemoptysis, haematemais or malena.

Occasionally present with symptoms from perforation.

Management

ABC’s resuscitate as per CPR protocols.

Obstruction with drooling & discomfort requires urgent endoscopic removal.

CXR (AP) determines diagnosis & position.

Fish bones:

· Try finding the above with direct/ indirect laryngoscope,

· Remove if seen, easily reachable & no evidence of perforation,

· Soft tissue X-Ray of the neck if located the throat & not in the mouth,

· Analgesia.

Generally, most patients with foreign bodies will require some form of follow-up.

External ear canal:

Usually seen in kids.

Insects should be killed first with peanut oil & then removed with alligator forceps or syringing

through a cut off butterfly line.

Most other objects (beads etc) need to be removed by getting behind them & pulling them out with

a curette or hook or occasionally syringing through a cut off butterfly line passed over the FB.

Always check the tympanum afterwards.

Give Sofradex drops afterwards if the canal is traumatized.

Nose:

Consider in any 2-5 year old with unilateral nasal discharge.

Anaesthetize nose with co-phenylcaine.

Button batteries must be removed with urgency.

Push the tip of the nose up & remove the FB with suction, angled blunt instrument behind the object or forceps.

Consider various “blowing” techniques!

Check the nose afterwards for trauma & other foreign bodies.

Recent Protocols

COVID 19

COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*

WARFARIN OVERDOSE/ TOXICITY

Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use

SUICIDAL IDEATION

Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.

SPINAL CORD INJURY

Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.