SPECIAL EMERGENCIES

Presented by: Group 5

The assessment of trauma victims requires an organized and systematic approach, NCBI (2023)

This systematic approach includes the Primary Survey which entails:

Airway- Assess the conscious patient's airway starting with talking to the patient and asking for his/her name to
see if they respond clearly and appropriately. This will help assess the patency of the airway. If the patient is
unconscious or not protecting their airway, assess the airway for obstruction and then perform intubation
immediately.

Breathing- Assess for equal rise and fall of the chest, respiratory rate, use of accessory muscles, and
adventitious breath sounds. If the injury is severe, provide the patient with supplemental O2 via a non-rebreather
mask.

Circulation- Assess for external hemorrhage or signs of shock like pallor. Palpate the patient's carotid and
femoral pulses while assessing if the skin is cold and diaphoretic. If bleeding is detected, apply direct pressure
with sterile bandages.

Disability- Measure the patient's consciousness using the Glasgow coma score (GCS). For patients with a GCS
of 8 or less, intubate the patient if not already achieved. Check pupils for size and reactivity. Then assess the
patient's motor ability and sensation in all 4 limbs.

Exposure- The fifth and final step of the primary survey includes removing all clothing to assess the site of injury.
Ocular Injuries
Emergencies in ophthalmology can be of various kinds ranging from
trauma cases to acute eye inflammations. Ocular trauma is an important
cause of visual loss and disability. Early and appropriate management
can reduce morbidity and complications (Emergency Medical Services
Division, 2018).
Conjunctivitis
Conjunctivitis is the inflammation of the conjunctiva. The
conjunctiva is a thin, translucent membrane that lines the
anterior part of the sclera and the inside of the eyelids
(Gordon-Shaag et al., 2019).

The three major types of conjunctivitis:

1. Bacterial
2. Viral
3. Allergic
Bacterial conjunctivitis

Classically characterized by acute onset of

purulent discharge, erythema, edema, chemosis,
and mattering of eyelids. (Murphy, 2018)
Hyperacute variant: severe copious purulent
discharge, eye pain, vision changes. Consider
gonorrhea/chalmydia in these patients.
Common organisms include S. Aureus, S.
Pneumonia, and H. Influenza.

Consider gonorrhea/chlamydia in sexually

active patients
Viral Conjunctivitis

Non-Herpetic: Presentation and Etiology

● Classically a thin, watery discharge, mild burning/irritation.
● 65-90% of cases caused by adenovirus.
● Pharyngoconjunctival fever: fever, pharyngitis, bilateral
conjunctivitis, periauricular node enlargement.
● Epidemic keratoconjunctivitis: watery discharge, chemosis, ipsilateral
lymphadenopathy, foreign body sensation.
Management

● Cold compresses, artificial

tears for comfort
● Hand washing to limit
spread
Viral Conjunctivitis
Herpetic:

Herpes Simplex:

● Typically unilateral, thin/watery discharge,

vesicular eyelid/oral lesions

● Treat with topical and oral antivirals

Allergic Conjunctivitis
Presentation and Etiology:
● Type I IgE mediated hypersensitivity reaction precipitated by allergens
● Allergens include: dust, pollens, animal dander, mites, mold
● Patients have bilateral itching, watery discharge, edema

Management:

● Eliminate the allergen.

● Topical tear substitutes to lubricate and wash out allergen
● Antihistamine drops can help itching/redness.
● Do not prescribe topical steroids unless in consultation with an ophthalmologist
Diagnostic Investigations
● History taking
● Clinical manifestations
● Examination of the eye

These are used to determine if the conjunctivitis is infectious or noninfectious. Eye

culture is used to determine whether the infectious agent is a bacterium or a virus.
This will also help to determine the antibiotic or antiviral used. (Centers for Disease
Control & Prevention, 2019)
Chemical Burns
Chemical exposures and burns are usually caused by a splash of liquid but can also be
caused by transferring a chemical from your hands to your eyes by rubbing or by being
sprayed by aerosols. Treatment should be instituted IMMEDIATELY, even before testing
vision, unless an open globe is suspected. (Bore, 2018)
This contains irritants (like mace) and alkali (like lye, cement, plaster, and airbag
powder). It also includes solvents, acids, and detergents. Alkalis can penetrate further
and cause greater harm because they cause saponification.
Signs & Symptoms of Chemical Eye Burns
● Pain
● Sensation of something in the eye
● Loss of Vision
● Redness
● Irritation
● Swelling of the eyelids
● Tearing
● Blurred vision
● Inability to keep the eye open
● Glaucoma
 Management
● Doctors likely will continue washing your eye. No standard exists for the amount of
washing required. Usually, doctors use at least 1L of fluid.
● Depending on the type of chemical involved, the doctor may test the pH of your eye and
continue washing until the pH returns to normal.
● You may receive topical anesthetic eye drops to numb your eye to make washing less
painful.
● Doctors will wipe or irrigate away any solid foreign material in your eye.
● If the burns are minor, you are usually sent home with antibiotic eye drops and oral pain
medications. Occasionally, you may be given dilating eye drops to help with comfort,
and your injured eye may be covered with an eye patch.
● Any significant burn, especially an alkali or hydrofluoric acid burn, may require
admission to the hospital.
 Exams and Tests
● The doctor determines what chemical caused the burn and
completes a thorough eye examination.
● You are given an eye examination using an eye chart to determine
how well you can see.
● Structures surrounding the eye are checked.
● Eyelids, in particular, require careful assessment. The doctor turns
them inside out to look for foreign material.
● The doctor may stain your eye with a dye called fluorescein to help
determine the extent of the damage.
Eye Traumas
Retinal Detachment

Results from separation of the sensory layer of the retina containing

the rod and cones from the pigmented epithelial layer beneath.
Requires surgery within days of diagnosis. (Tasmanian Eye Institute,
n.d.)

● It may occur spontaneously because of degenerative changes

in the retina (as in diabetic retinopathy) or vitreous humor,
trauma, inflammation, tumor, or loss of a lens to a cataract.
● It is rare in children, the disorder most commonly occurs after
age 40.
● Untreated retinal detachment results in loss of a portion of the
visual field.
Causes/Risk factors
Modifiable
● Hemorrhage
● Exudates that occur in front of or behind the retina
● Sudden, severe physical exertion especially in persons who
are debilitated.

Non-modifiable
● Myopic degeneration
Symptoms of Retinal Detachment

● Initially, the patient complains of flashes of light, floating spots or filaments

in the vitreous, or blurred, “sooty” vision.
● If detachment progresses rapidly, the patient may report a veil-like curtain or
shadow obscuring portions of the visual field. The veil appears to come
from above, below, or from one side; the patient may initially mistake the
obstruction for a drooping eyelid or elevated cheek.
● Straight-ahead vision may be unaffected in early stages but, as detachment
progresses, there will be loss of central as well as peripheral vision.
Diagnostic Evaluation

Ophthalmoscopy or slit-lamp
examination with full pupil dilation
shows retina as gray or opaque in
detached areas. The retina is normally
transparent.
Corneal Laceration

A corneal laceration is a cut on the cornea. It is

usually caused by something sharp flying into the
eye. It can also be caused by something striking the
eye with significant force. A corneal laceration is
deeper than a corneal abrasion, cutting partially or
fully through the cornea. (Porter, 2022)
Signs & Symptoms
● Severe pain
● Tearing
● Sensitivity to light
● Blurred or decreased vision
● Bleeding (blood in the eye)
● The feeling that there is something in the eye
● Partial-thickness laceration signs
○ The anterior chamber is not entered and,
therefore, the cornea is not perforated.
Management
Work-up

Careful examination should be performed to exclude ocular penetration.

Carefully evaluate the conjunctiva and sclera, checking for extension
beyond the limbus in cases involving the corneal periphery.

Treatment

● An antibiotic (e.g., chloramphenicol or ciprofloxacin) drops 2

hourly for a week, antibiotic ointment and eye pad on the 1st day.
● When a moderate to deep corneal laceration is accompanied by
wound gape, it may need repair.
OTOLARYNGOLOGY
(EAR)

Presenter: Orlyah Bryan

AREA OF FOCUS
• Removal of insects vs
Vegetative matter
• Traumatic Tympanic
Membrane Rupture
• Otitis Media

26
WHAT IS A FOREIGN BODY?

A foreign body is something that is stuck inside you but isn't

supposed to be there. You may inhale or swallow a foreign body,
or you may get one from an injury to almost any part of your
body (National Library of Medicine, 2021).
REMOVAL OF INSECTS VS VEGETATIVE
MATTER
•Insects can fly or crawl into the
ear canal especially while
sleeping.
•Vegetative matter like seeds,
plant materials or wax buildup,
can get stuck in the ear.

28
CAUSE/RISK FACTORS
• Children 9 years and under are
most at risk for having objects/
vegetative matter in ear are
normally placed there.
• Campers and people who sleep
on the floor are also most at risk
of having insects crawling into
their ear

29
SIGNS AND SYMPTOMS
∙ Bleeding
∙ Severe pain
∙ Itching
∙ Ringing
∙ Ear Infection
∙ Decrease in hearing

30
 EMERGENCY MANAGEMENT

• Using an Otoscope to locate foreign objects/ insects

• Insects in the ear canal are often killed with either lidocaine (an
anesthetic) or mineral oil.
• Small children are usually sedated medically before foreign bodies
removed from their ears.
• After the foreign body is removed antibiotic drops may be given
to prevent infection from trauma to the ear canal.
• It is contraindicated to use water or other liquids to remove
vegetative matter as these are prone to absorb water and swell.
 TECHNIQUES USED TO REMOVE
FOREIGN OBJECTS FROM THE EAR

• Modified tweezers or forceps can be used to reach in and grab the

object with the help of an otoscope so important structures are not
damaged.
• Gentle suctioning recommended for vegetative matter
• Irrigation of the canal with warm water and a small catheter
 TRAUMATIC TYMPANIC MEMBRANE RUPTURE

• This condition is explained by (Sachdev,

2022) as, “a tear in the tympanic
membrane”. The tympanic membrane is a
thin tissue found between the outer and
inner ear. This membrane is very
important as it protects the inner and
middle ear from foreign objects and
bacteria.
33
CAUSE/RISK FACTORS
• Ear infection- During an ear infection, fluids accumulate
behind the eardrums.” This puss-like fluid causes
pressure and may cause a rupture
• Foreign objects- Cotton swabs or hair pins are common
causes of eardrum rupture as these objects are often
pushed far in the ear
• Barotrauma- Injury of a body part or organ because of
changes in barometric pressure.
• Injury to the head- Damage to the ear or the side of the
head can rupture the eardrum.
34
SIGNS AND SYMPTOMS

• Pain

• Bleeding

• Puss-like drainage from the ear

• Temporary or reduced loss of hearing

in the affected ear
• A ringing or buzzing in the ears

• Dizziness

35
 DIAGNOSIS OF TRAUMATIC TYMPANIC MEMBRANE RUPTURE

• Laboratory tests- To detect the bacteria that caused the infection

• Otoscopy- Perforation is generally evident on otoscopy
• Audiometry- Audiometric studies are done before and after treatment to avoid
confusion between trauma-induced and treatment-induced hearing loss.
• Tympanometry- Measures the response of the eardrum to slight changes in air
pressure which can indicate a perforated eardrum.
• Tuning Fork Evaluation- Reveal if hearing loss is caused by damage to the
vibrating parts of the middle ear and damage to sensors or nerves of the inner ear.
 TREATMENT OF TRAUMATIC
TYMPANIC MEMBRANE RUPTURE
• Ear kept dry
• Eardrum patch
• If the ear becomes infected, Amoxicillin 500 mg orally every 8 hours is
given for 7 days.
• Surgery- Hardly ever performed as it heals on it own but surgery may be
needed if condition persists longer than 2 months or if Persistent
conductive hearing loss suggests disruption of the ossicular chain which
requires surgical exploration and repair.
 OTITIS MEDIA

• This condition is an inflammation of the

middle ear. This ear infection is most
common in children.
• Otitis Media is caused by a bacteria or a
virus. This infection is the result of a fever,
flu, or allergies that causes increased mucus
production. This may lead to a fluid build up
and a blockage of the eustachian tube.

38
TYPES OF OTITIS MEDIA
• Acute Otitis Media- This type of inflammation occurs abruptly
with a respiratory illness and is normally accompanied by redness
and swelling as fluid and mucus gets trapped in the ear
• Otitis Media with Effusion- Is the continuous accumulation of
fluid in the ear after the respiratory infection has been cured.
• Chronic Otitis Media- When fluid remains in the ear for
extended periods of times and returns continuously without any
Respiratory infections
 RISK FACTORS
• Age- Young children are most at risk for ear infection. Babies who drink from
a bottle, especially in a sleeping position, are more susceptible to ear
infections than babies who are exclusively breastfed.
• Gender- Males are more at risk than women
• Environmental conditions- Places with high levels of pollutants or poor air
quality
• Smoking- Cigarette smoke can enter the ear directly and cause ear infections.
• Poor immune system- The body is vulnerable to infections.
• Cleft lip condition- This condition makes fluid removal in the eustachian
tube.
SIGNS AND SYMPTOMS

• Pain in the ear (otalgia)

• Irritability
• Fever
• Sleep disorders
• Pulling the ear
DIAGNOSTIC PROCEDURES
• Pneumatic Otoscopy- Allows the doctor to look in the ear
and judge whether there is fluid behind the eardrum by
gently puffs air against the eardrum.
• Tympanometry- Measures the movement of the eardrum.
• Acoustic Reflectometry- This test measures how much
sound is reflected back from the eardrum.
• Tympanocentesis- A doctor may use a tiny tube that pierces
the eardrum to drain fluid from the middle ear.
TREATMENT
• Painkillers
• Antibiotics
• Myringotomy- A surgical
procedure that involves making
a small hole in the eardrum to
drain fluid and relieve pressure
 THE NOSE

Presenter: Shay-Ann Charlton

Foreign bodies from the nose: Definition

The medical term is Nasal Foreign

Bodies (NFB) and it is considered as a
common emergency seen in the
Emergency Department especially
among children and adults with mental
disabilities.
 Causes

● Curiosity (most common cause)

● Trying to smell something and NFB enters the nose
● Copying other children
Signs and Symptoms
● Unilateral purulent rhinorrhea (most common)
● Epistaxis (nosebleed)
● Pain
● Irritation
● Chronic sinusitis
● Unilateral nare obstruction
● New-onset snoring
● Sneezing
● Wheezing
● Stridor
● Unilateral facial swelling
Emergency Management: Diagnostic Tests

In the event that an NFB is

visualized when an anterior
rhinoscopy is done, imaging may
not be necessary.
Emergency Management: Diagnostic Tests

If the NFB is not visible and the kind of NFB is obscure, the
following tests can be requested:
● Plain radiography
● Flexible or rigid endoscopy
● Computed tomography (CT) scanning
● Magnetic resonance imaging (MRI)
Rigid Endoscopy

Flexible Endoscopy

Radiography/
Computed tomography (CT) scanning

Magnetic resonance imaging (MRI)

Emergency Management: Removal Techniques
Noninvasive techniques
● Forced exhalation
● Mother's/Parent’s kiss
Direct instrumentation
● Ideal for nonspherical and non friable NFBs
● Well-visible
● In reach of instruments used
● Recommended instruments: hemostats, alligator forceps, and
bayonet forceps.
Emergency Management: Removal Techniques
Hooked probes
● Also called right-angle hooks
● Ideal to remove well visible NFBs but difficult to grip

Balloon catheters
● Perfect for little, circular objects that are not effectively
griped by direct instrumentation
● Following catheters can be used for NFB removal:Foley
catheters, Fogarty catheters and Katz Extractor Oto-
Rhino Foreign Body Remover
Emergency Management: Removal Techniques

Suction
● ideal for easily visualized, smooth or spherical foreign
bodies
Glue
● ideal for easily visualized smooth/spherical foreign
bodies that are dry and non friable
● should be used only in patients who can fully cooperate
because the nasal mucosa can be easily damaged
Emergency Management: Removal Techniques

Irrigation
● Ideal for non graspable, round,
smooth or friable (eg: beads)
● Not recommended due to
significant risk of aspiration or
choking
Emergency Management: Removal Techniques

Posterior Displacement of Nasal Foreign Bodies

● For further posterior displacement of the object into the
oropharynx,consultation with a specialist (ENT) may be required
in order to remove it.
● However, this technique should only be done under general
anesthesia and endotracheal intubation due to the risk posed by a
dislodged NFB in the airway.
● Here is a YouTube link to summarize the removal techniques:
https://youtu.be/QBcvcn5C0ic?si=VQOksFOoMXlRbauS
Fracture of Nasal Bone: Definition & Causes
● Also called a broken nose
● Break/crack in the bridge of the nose
May be caused by:
● Injury from contact sports, such as football or
hockey
● Physical fights
● Motor vehicle accidents
● Falls
● Walking into a fixed objects like a wall
Signs and Symptoms
● Pain/tenderness when nose is plapted
● Swelling of your nose and surrounding areas
● Bleeding from your nose
● Bruising around your nose or eyes
● Crooked nose
● Difficulty breathing through your nose
● Discharge of mucus from your nose
● Feeling that one or both of your nasal passages are blocked
Emergency Management: Diagnostic Tests
● Physical Examination: Observe skin for discoloration and
laceration, inspect nose for swelling, bleeding, disformity
Emergency Management: Diagnostic Tests

Laboratory Studies
● Complete Blood Count
● Coagulation studies (PT and PTT)
● Blood typing and cross matching for red blood cells

Imaging Studies
● Facial X Rays
● CT scan
● Digital volume tomography (DVT)
Emergency Management: Procedures

Closed and Open Reduction

"Closed" implies that no skin or nasal incisions are made in
order to realign the fractured nasal bones. If an incision is
necessary to repair a broken nose, the phrase "open" is used.

Rhinoplasty
Also called a nose job is surgery on the nose to change its shape
or improve its function
Epistaxis
Epistaxis: Definition
● Also known as a nose bleed
● Happens when the mucosa is eroded and vessels
become exposed and subsequently break
Types of Epistaxis
There are two types:
1. Anterior bleeds- 90%
2. Posterior bleeds- 10%
Signs and Symptoms

● Bleeding from either or both nostrils

● Blood flowing at the back of the throat
● Urge to swallow frequently
● Persistent bleeding: dizziness, weakness, confusion, fainting
and dark, tarry stools because blood was swallowed
Emergency Management: General First Aid
Compressing the nostrils by applying direct pressure to the septal
area and stuffing the affected nostril with gauze or cotton that has
been soaked in a topical decongestant are two initial therapy
techniques.
Continuous direct pressure should be used for at least five minutes
and a maximum of twenty minutes. By tilting the head forward,
nausea and airway congestion are avoided since blood cannot collect
in the posterior pharynx
Emergency Management:
Examination of nose should be done in a brightly-lighted room,
patient seated and clothed in a sheet/gown. The physician should wear
PPEs (e.g., surgical mask, safety glasses). The use of a headlamp/head
mirror and nasal speculum is optimal visualization.
Epistaxis tray can be created containing common supplies and a
few specialized instruments. Clots and foreign bodies in the anterior
nasal cavity can be removed with a small (Frazier) suction tip,
irrigation, forceps, and cotton-tipped applicators.
Emergency Management
Emergency Management: Anterior Bleeds
● When an anterior bleeding site is found, vasoconstriction with
topical application of 4% phenylephrine solution.

● If bleeding require a more aggressive treatment, a local

anesthetic, such as a 4% tetracaine or lidocaine (Xylocaine)
solution, should be used. Enough anesthesia should be
obtained before treatment proceeds.
Emergency Management: Anterior Bleeds
Emergency Management: Posterior Bleeds
When a posterior bleeding site is found (less common), it is treated
by an otolaryngologist. Posterior packing is done by passing a catheter
through one or both nostrils, to the nasopharynx and out the mouth.
Then a gauze pack is secured to the end of the catheter and
positioned to the posterior nasopharynx by pulling back on the
catheter until the pack is seated in the posterior choana, sealing the
posterior nasal passage and applying pressure to the site of the
posterior bleeding.
Emergency Management
When an anterior or posterior bleeding continues despite packing
or balloon procedures, treatment by an otolaryngologist is needed.
● Nasal cauterization - Burn the artery at the bleeding site
Emergency Management
● Arterial ligation - Tie off the arteries causing the bleed

● Angiographic arterial embolization - Plugging of artery at bleeding

to stop bleeding
THE THROAT (PHARYNX)

Presenter: Melissa McLean

Parts of the Pharynx
Foreign Body in the Throat
Stanford Medicine Children’s Health (2021) states that
children under 4 years old are in the greatest danger of
choking on small objects, including, but not limited to,
the following:
● Nuts 🥜 ● Grapes 🍇
● Seeds🫘 ● Hot dogs 🌭
● Carrots🥕 ● Pebbles 🪨
● Toy parts🧸🚙 ● Buttons 🔘📿
● Batteries 🔋 ● Coins 🪙
Symptoms of a Foreign Body in the Airway
● Choking or gagging when the object is first inhaled
● Coughing
● Stridor
● Wheezing
● Pneumonia
● Voice changes
Symptoms of a Foreign Body in the Esophagus
When there is a foreign body in the esophagus may have
any or all of the following:
● An initial choking episode
● Drooling
● Vomiting whenever trying to eat
● Inability to eat
Removal of Foreign Body from the Throat

If the foreign body is in the airway

A laryngoscopy and bronchoscopy will be
performed. This procedure involves inserting a
rigid scope into the airway, examining the
airway to locate the foreign body then
removing it using specialized forceps.
Bronchoscopy
Removal of Foreign Body from the Throat

If the foreign body is in the esophagus

A scope is passed into the esophagus
(esophagoscopy) and special tools are
used to remove the stuck, swallowed item.
Once the foreign body is removed the
individual typically recovers quickly.
Removal of Foreign Body from the Throat
Heimlich Maneuver
Peritonsillar Abscess: Definition
A peritonsillar abscess is a swollen pus-filled pocket
that forms near one of your tonsils. It is usually quite
painful and can make it difficult to open your mouth.
Quinsy is another name for peritonsillar abscess.
(Cleveland Clinic, 2023)
Peritonsillar Abscess: Causes

Harvard Health (2022) confirmed that in most instances,

peritonsillar abscesses are caused by "strep throat"
bacteria called group A beta-hemolytic streptococci.
Quinsy is usually a complication of tonsillitis.
Group A beta-hemolytic streptococci
Peritonsillar Abscess: Risk Factors
● Gum infections
○ Periodontitis and gingivitis
● Chronic tonsillitis
● Infectious mononucleosis
● Smoking
● Chronic lymphocytic leukemia (CLL)
● Tonsilloliths
Peritonsillar Abscess: Signs & Symptoms
● The first symptom is usually a sore throat.
● A period without fever or other symptoms may follow as
the abscess develops.
● It is not unusual for a delay of 2 to 5 days between the
start of symptoms and abscess formation.
● The mouth and throat may show a swollen area of
inflammation usually on one side.
● The uvula may be shoved away from the swollen side of
the mouth.
● Lymph glands in the neck may be enlarged and tender.
 Peritonsillar Abscess: Signs & Symptoms
Other signs and symptoms may be observed:
● Painful swallowing
● Fever and chills
● Spasm in the muscles of the jaw (trismus) and neck (torticollis)
● Ear pain on the same side as the abscess
● Headache
● A muffled voice, often described as a "hot potato" voice
● Difficulty swallowing saliva
● Drooling
● Bad breath
Peritonsillar Abscess: Emergency Management
History & Physical Exam
● A peritonsillar abscess is easy to diagnose when it is large
enough to see.
● The doctor will look into your mouth using a light and,
possibly, a tongue depressor.
● Swelling and redness on one side of the throat near the
tonsil suggests an abscess.
● The doctor may also gently push on the area with a
gloved finger to see if there is pus from infection inside.
Peritonsillar Abscess: Emergency Management
Diagnostic Tests
● X-ray, CT scan, or an ultrasound will be performed:
○ Epiglottitis
○ Retropharyngeal abscess
○ Peritonsillar cellulitis
● Test for mononucleosis
● Pus from the abscess is collected and sent to the lab
 Peritonsillar Abscess: Emergency Management
Medical Treatment
● The primary concern will be patient's breathing and airway.
● If the patient's life is in danger because the throat is blocked:
○ Needle aspiration
○ Incision and drainage
○ Suction
● If not in immediate danger:
○ Local anesthetic
○ Pain medicine and sedation through an IV inserted in the arm.
● Acute tonsillectomy
● Antibiotic therapy
Ludwig’s Angina
Ludwig’s Angina: Definition
Ludwig’s angina is life-threatening
cellulitis of the soft tissue involving
the floor of the mouth and neck.
The condition gets its name from
German physician Wilhelm Frederick
von Ludwig who first described it in
1836.

Wilhelm Frederick von Ludwig

(1790-1865)
Ludwig’s Angina: Nomenclature
Ludwig angina involves 3 parts of the floor of the mouth:
1. Sublingual space
2. Submental triangle
3. Submandibular space
Hence it is also called
● Sublingual space infection
● Submandibular space infection
Ludwig’s Angina: Floor of the Mouth & Neck
Ludwig’s Angina: Causes

● Poor oral hygiene

● Abscessed tooth (lower molars) mainly 2nd and 3rd
○ Accounts for over 90% of cases
● Group A streptococcal infections
○ Streptococcus viridans
● Staphylococcal infections
○ Staphylococcus aureus
Staphylococcus aureus Streptococcus viridans
Ludwig’s Angina: Risk Factors
● A broken jaw (facial fracture).
● Cavities, a fractured tooth (cracked tooth) or a tooth
extraction
● Diabetes
● Malnutrition
● Oral cancer
● Poor oral hygiene
● Substance use disorder
● Tongue piercings
● Weakened immune system
Ludwig’s Angina: Signs & Symptoms
● Difficulty speaking
● Fever or chills
● Jaw pain
● Neck pain, swelling or redness
● Protruding or swollen tongue
● Swollen cheeks and jaw
● Tongue tenderness or pain under the tongue
● Toothache
Ludwig’s Angina: Signs & Symptoms
Ludwig’s Angina: Emergency Management
History & Physical Exam
● History of oral infections, dental caries and
tooth extraction
● Assessment of the neck, jaw, lymph nodes,
the inside of the mouth, chest and lungs.
Ludwig’s Angina: Emergency Management
Diagnostic Tests
● CT scan
● MRI
● Blood and salivary cultures
Ludwig’s Angina: Emergency Management
Medical Treatment
● The first treatment is to ensure patent airway and
breathing
○ Tracheostomy
● IV antibiotics followed by oral antibiotics.
● Surgical tooth extraction
● Incision and drainage
Presenter: Kemara Jackson
 LONG BONE FRACTURES

Definition

Long Bone Fractures are characterized as soft

tissue wounds with a partial or complete break in

the continuity of the involved long bones., Para

(2022).
 LONG BONE FRACTURES

Causes Risk factor

1. Trauma Osteoporosis

● Car accidents. Osteoporosis weakens bones, making them more susceptible

to sudden and unexpected fractures, Cleveland Clinic.
● Sport injuries Medical (2022)
1. Repetitive Forces

● Running

● Performing the same action repeatedly

over an extended period of time

 LONG BONE FRACTURES
Signs and Symptoms

1. Pain

2. Swelling

3. Tenderness

4. Inability to move a part of your body like you usually can

5. Bruising or discoloration

6. A deformity or bump that’s not usually on your body

 DIAGNOSIS OF LONG BONE FRACTURES
The 5 P's of circulation assessment is used:

1. Pain- Assess on a standardized scale typically from 0 to 10, with 10 being the worst pain
ever experienced. Under typical conditions, pain should primarily be localized to the
injury site and not be out of proportion to the severity of the injury.
2. Pulse- Assess the characteristics of the pulse distal to the fracture for quality, rate, and
rhythm. Grade the pulse using a scale from 0 to 4+ (0 indicates no pulse and 4+ indicates
bounding pulse).
3. Pallor- Pallor or paleness distal to the fracture indicates reduced blood flow. When the
blood flow is interrupted, skin discoloration (bluish or purplish) and increased capillary
refill can be observed.
4. Paresthesia- Indicates damage to the nerves. The patient may complain of numbness,
tingling, or pin or needle pricking sensation injured limb.
5. Paralysis- The inability to move a fractured limb.
 DIAGNOSIS OF LONG BONE FRACTURES

IMAGING TESTS

X-rays: to confirm the fractures, and show how damaged the bones are.

MRI: To get a complete picture of the damage to your bones and the area around them.

CT scan: To provide a more detailed picture of the bones and the surrounding tissues.
 TREATMENTS OF LONG BONE FRACTURES

1. Immobilization

If the fracture is mild or non-displaced a splint may

be used. The purpose of a splint is to prevent

movement of the broken or dislocated bone. Splints

reduce pain, and help prevent further damage.

 TREATMENTS OF LONG BONE FRACTURES

For more severe fractures, the following may be used:

1. Closed reduction- In this non-surgical procedure,

an analgesic will be first administered to numb the

limb, then the doctor will physically pull and push

on the outside of the body to realign the bone

 TREATMENTS OF LONG BONE FRACTURES

2. Internal fixation- For this procedure, the trauma 3. External fixation- For this procedure, the

surgeon will properly realign the shattered bone, surgeon will drill screws into the patient's bone on

then fix it in place so that it can mend and grow back each side of the fracture. This is typically a short-

together. In order to hold the bone in place while it term solution to support the fracture and give the

heals, little metal bits are inserted into the bone. patient's body time to heal before receiving an

internal fixation.
 PELVIC FRACTURES
Definition

A pelvic fracture occurs when one or more of the

bones that make up the pelvis are broken or

fractured. The Pelvis is the region of the body below

the abdomen that lies between your hip bones.

Cleveland. Clinic. Medical (2021).

 PELVIC FRACTURES

Signs and Symptoms

● Pain or numbness in the groin, hip, and/or lower

back.

● Intense pain when walking or moving the legs.

● Pain in the abdomen.

● Difficulty time passing urine, walking or standing

 PELVIC FRACTURES
Risk factors
Causes

● Having osteoporosis
● High-impact events: such as a car accident or falling from
● Having a history of falls
a significant height.
● Playing certain sports such as running
● Bone-weakening diseases: such as osteoporosis can

result in pelvic fractures when doing a routine activity or or football

from a minor fall.

● Athletic activities: such as running can cause a tendon or

ligament to tear away from the bone to which it’s attached.

 DIAGNOSIS OF PELVIC FRACTURES

Physical exam
Imaging tests

The doctor will examine the hip and pelvis to assess

● X-rays
the extent of swelling, bruising, and tenderness. If
● CT scan
there are signs of an open fracture, the doctor
● MRI
diagnoses it quickly and often performs immediate

surgery.
 TREATMENTS OF PELVIC FRACTURES

● The use of pelvic stabilizers

This is used to control hemorrhage and stabilize the

pelvis by firmly tying the binder around the greater

trochanters to provide adequate compression..

 TREATMENTS OF PELVIC FRACTURES
● Medications: such as analgesics and blood thinners to prevent clot formation in veins of the legs and pelvis.

For severe fractures:

● External fixation

● Skeletal traction

● Open reduction

● Internal fixation

NOTE: It is highly recommended that a urinary catheter should not be inserted until urethral injury has been ruled

out (Moore, 2023).

 COMPARTMENT SYNDROME
Definition:

Compartment Syndrome (CS) arises when an internal

compartment experiences swelling or bleeding. Due
to the fascia's inability to stretch, the capillaries,
nerves, and muscles in the compartment may
experience increased pressure, which can reduce
blood flow to the muscles and nerve cells (OrthoInfo,
2022).

There are two (2) types of CS:

1. Acute CS
2. Chronic CS
 COMPARTMENT SYNDROME

CAUSES OF ACUTE CS CAUSES OF CHRONIC CS

● Exercise/ repetitive motions, such as

● Trauma
running or marching,
● A fracture
● A badly bruised muscle
● Reestablished blood flow after blocked
circulation
● Anabolic steroid use
● Constricting bandages such as casts and
tight bandages
 COMPARTMENT SYNDROME

Signs and Symptoms of Acute CS Signs and Symptoms of Chronic CS

● Severe pain, especially when the muscle ● Pain or cramping during exercise

within the compartment is stretched. ● Numbness

● Tingling or burning sensations ● Difficulty moving the foot

(paresthesia) in the skin. ● Visible muscle bulging

● The muscle may feel tight or full.

● Numbness or paralysis
 DIAGNOSIS OF COMPARTMENT SYNDROME
● Physical exam: To diagnose chronic compartment syndrome, your doctor must rule out other
conditions that could also cause pain in the lower leg. For example, your doctor may press on
your tendons to make sure you do not have tendinitis. Additionally, they will assess the 5 P’s
● X-ray
● Compartment pressure measurement test: The provider will insert a needle into the muscle. A
machine attached to the needle will give the pressure reading. The healthcare provider may
insert the needle in several different places.
● Repeat pressure test: For exertional compartment syndrome, the test gets repeated after you
exercise. The healthcare provider will compare before and after results.
TREATMENT OF ACUTE COMPARTMENT SYNDROME

● Fasciotomy- During a fasciotomy, the surgeon makes cuts around

the muscle to relieve the pressure. Sometimes, skin may need to be

removed from another part of the body and used to cover the

wound. This is known as a skin graft.

● Additionally, medications such as: non-steroidal anti-inflammatory

drugs (NSAIDs) may be used to reduce inflammation and swelling

in the affected muscle compartments and alleviate pain

TREATMENTS OF CHRONIC COMPARTMENT SYNDROME

Surgery is often not needed for chronic compartment syndrome.

However, if the suggested preventative methods do not work to help

relieve symptoms (physiotherapy, medication, avoiding the activity

that caused it, or orthotics) a similar surgery to the one used to treat

acute compartment syndrome will be necessary

 DISLOCATED JOINTS
Definition

Dislocation is the medical term for bones in one of

your joints being knocked or pushed out of their

usual place, Cleveland Clinic Medical (2023)

 DISLOCATED JOINTS

Symptoms of a dislocated joint

● Pain.

● Swelling.

● Bruising.

● The joint looks noticeably different or out of

place.

● Being unable to move or use your joint.

● A feeling of instability or like the joint is

weaker than usual

 DISLOCATED JOINTS

Causes Risk factors of a dislocated joint

● Car accidents. ● Person who play contact sports.

● Sports injuries. ● Are older than 65.

● Falls. ● Have Ehlers-Danlos syndrome or another health condition

that weakens connective tissues (including ligaments,

tendons, or muscles) around joints.

 DIAGNOSIS OF DISLOCATED JOINT
● X-rays.

● Magnetic resonance imaging (MRI).

● A computed tomography (CT) scan.

● Ultrasound.
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