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Paramedic Care: Principles & Practice Fourth Edition Volume 4: Medicine CHAPTER 12 Diseases of the Eyes, Ears, Nose, and Throat Standard • Medicine (Diseases of the Eyes, Ears, Nose, and Throat) ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Competency • Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Introduction • Head and neck contain many of body's essential sensory organs and important structures. • This chapter addresses nontraumatic conditions of head and neck. • Important structures: eyes, ears, nose, throat, associated structures. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Eyes are organs of sight. • Gather light and focus light onto receptors in back of eye that produce image interpreted by brain. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • External Anatomy of the Eye – Protected by bones (ocular orbit). – Orbit padded with subcutaneous tissue; cushions and protects eye from injury. – Movement of eyes controlled by six extraocular muscle; allow us to look in various directions. – Two movable folds of skin (eyelids) protect eyes from environment. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • External Anatomy of the Eye – Eyelashes function as sensors to cause rapid closure of eyelids when foreign substance approaches eyes. – Glands secrete oily substance (sebum) onto eyelids to keep them soft and pliable. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • External Anatomy of the Eye – Membrane (conjunctiva) covers and protects exposed surface of eye. – Each eye has lacrimal apparatus; manufactures and stores tears. – Tears manufactured in lacrimal glands; spread across eye where they drain through lacrimal ducts into nose. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. External anatomy of the eye. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Internal Anatomy of the Eye – Globe: two distinct fluid-filled cavities. – Posterior cavity, portion of eye behind lens, contains vitreous humor. – Vitreous humor: clear, jellylike fluid that fills entire vitreous cavity. – Anterior cavity: portion of eye in front of lens, contains aqueous humor. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Internal Anatomy of the Eye – Aqueous humor: waterlike fluid that surrounds iris, pupil, lens. – Anterior cavity divided into anterior chamber and posterior chamber. – Both chambers filled with aqueous humor. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Internal Anatomy of the Eye – Innermost layer: retina. – Middle layer: choroid. – Outermost layer: sclera. – Sclera: tough, fibrous, protective tissue; ("whites of the eyes"). – Cornea: transparent, curved portion of sclera; allows light to pass into eye and onto retina. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Internal Anatomy of the Eye – Choroid: highly vascular tissue; provides essential nutrients to tissues of eye; contains iris and pupil. – Iris: colored portion of eye; controls size of pupil; changes diameter of pupillary opening. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Internal Anatomy of the Eye – Behind pupil is lens; focuses incoming light images onto retina. – Ciliary muscles surround lens; change shape of lens to focus incoming image. – Retina contains nerve endings; receives and interprets incoming image. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Internal Anatomy of the Eye – Retina: contains two types of lightsensing receptors (rods and cones). – Rods effective in dim light and do not perceive color; cones more effective in bright light and do perceive color. – Chemical change sends impulses to optic nerve and brain, where image interpreted. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Internal anatomy of the eye. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Sty(e) (external hordeolum) Infection of eyelid; blockage of oil glands associated with eyelash. Located at lash line; small pustule/lump. Resolves when gland blockage relieved; warm soaks, topical antibiotics. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Chalazion (internal hordeolum) Inflammation or infection; blockage of meibomian glands in tarsal plate of eyelid. Meibomian glands produce fluid that lubricates eyelids. Red, tender lump in eyelid or margin. Treatment: similar to that for sty; may require antibiotics. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Conjunctivitis Infection or inflammation of conjunctiva. – Bacterial conjunctivitis ("pinkeye"). – Limited to conjunctiva; cornea is clear. – Red and itching; more tears than usual. – Treatment: topical antibiotics. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Conjunctivitis. (© Dorling Kindersley) ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Conjunctivitis Infection or inflammation of conjunctiva. – Viral conjunctivitis:similar to bacterial conjunctivitis. – Cause is viral. – Treatment is symptomatic. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Conjunctivitis Infection or inflammation of conjunctiva – Allergic conjunctivitis: exposure to pollen and antigens to which patient allergic. – Redness, watery discharge, itching, swelling. – Tends to be seasonal; oral and topical ocular antihistamines. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Pterygium Conjunctival condition; raised, wedgeshaped growth of conjunctiva. Noncancerous; visible over white sclera. Common in people who have increased outdoor exposure to sun, wind, dust. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Iritis (uveitis) Swelling/irritation of middle layer of eye. Patients with autoimmune diseases. Anterior uveitis: inflammation of front part of eye (iritis). Posterior uveitis: back part of choroid (choroiditis). Can affect one or both eyes. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Iritis (uveitis) Blurred vision, eye pain, erythema, photosensitivity, floaters. Treatment: protection from light, analgesia, corticosteroid eye drops. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Herpes simplex virus (HSV) keratitis Infection and inflammation of cornea; herpes simplex virus. Frequent cause of corneal blindness; reason for corneal transplantation. Pain, photophobia, blurry vision, tearing, erythema. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Herpes zoster ophthalmicus Herpes zoster (shingles) affects eye. Virus spreads along first division of trigeminal nerve. Damage can result to eye itself; ulcer or similar lesion on cornea. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Corneal ulcers Infection of cornea by infectious agent; breaks through epithelial of cornea. Serious and sight-threatening infections. Painful red eye, tearing, photophobia. Viral infections treated differently than bacterial infections. Evaluation by ophthalmologist essential. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Cellulitis Soft tissues surrounding eye infected. Sight-threatening and life-threatening condition. Periorbital cellulitis (preseptal): has not breached orbital septum. Edematous, erythematous, warm eyelids and surrounding tissues. Eye itself not involved. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Cellulitis Periorbital cellulitis (preseptal): usually bacterial; risk for children. Pain, conjunctivitis, blurred vision, increased tear production. Treatment: potent antibiotics; hospital admission. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Cellulitis Orbital cellulitis (postseptal): serious infection; structures behind orbital septum. Complication of periorbital cellulitis and sinus infections. Common in winter months. Fever, headache, eyelid edema, runny nose, generalized malaise. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Cellulitis Orbital cellulitis (postseptal): protrusion of eye; inability to move eye because of infection and swelling. Pain with eye movement, decreased vision, inflammation of conjunctiva. Requires hospitalization, potent antibiotics, surgical drainage; true emergency. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Hyphema Collection of blood in anterior chamber of eye; result of trauma. Nontraumatic conditions: sickle cell disease, diabetes, tumors of eye. Sight-threatening condition; evaluation by ophthalmologist indicated. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Glaucoma Group of eye sight-threatening eye conditions. Increase in pressure within eye (intraocular pressure [IOP]). Damages optic nerve; second cause of blindness in U.S. Blockage of flow of aqueous humor from anterior chamber. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Glaucoma Angle-closure glaucoma: outflow of aqueous humor suddenly blocked; causes rapid and severe increase in IOP. Open-angle glaucoma: most common type; IOP increases slowly over time. Places pressure on optic nerve and retina; can lead to blindness. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Glaucoma Open-angle: no symptoms; begin to lose vision. Angle-closure: develop severe pain in affected eye; decreased or cloudy vision; red and swollen; rainbow- or halo-like effects around lights. Acute angle-closure: treatment is to reduce IOP; medications or surgery. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Cataract Clouding of lens of eye. Associated with aging; breakdown of proteins within lens. Risk factors: diabetes, eye injury, radiation exposure, smoking, exposure to ultraviolet light (sunlight). ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Cataract Decreased vision, cloudy or fuzzy vision, light sensitivity, diplopia, loss of color intensity, halos around lights. Treatment: prevention; surgical removal. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Cataract. (National Eye Institute, National Institutes of Health) ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Optic neuritis Inflammation of optic nerve. Result of autoimmune diseases; infections, drug toxicity, multiple sclerosis. Loss of vision in single eye in an hour; loss of color vision, changes in pupillary reaction to light, pain with eye movement. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Optic neuritis Vision returns to normal within 2 to 3 weeks without treatment. Corticosteroids used. Ophthalmologic evaluation essential. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Papilledema Not condition per se; swelling of optic disc secondary to increased intracranial pressure. Optic disc: region of retina where fibers of optic nerve enter eye. Causes: trauma, infections within brain, stroke, tumors, hydrocephalus. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Central retinal artery occlusion Blockage of small arteries that supply retina; results from thrombus or atherosclerotic plaque. Common source of clots. Common in diabetics, patients with arrhythmias, those with valvular heart disease, intravenous drug abusers. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Central retinal artery occlusion Symptoms: involve all or part of one eye; last from few seconds to minutes. Blockage can be permanent. Treatment: fibrinolytics; massaging eye. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Central retinal vein occlusion Blockage of small veins that drain retina; caused by atherosclerosis or thrombus. Common in diabetics, hypertension, atherosclerosis, other eye conditions such as glaucoma. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Central retinal vein occlusion Symptoms: sudden blurring or vision loss in all or part of one eye. Regain vision without treatment; rarely returns to normal. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Retinal detachment Separation of retina from supporting structures. Unknown causes; trauma, diabetes. Bright flashes of light in peripheral vision. Blurred vision; "floaters" in eye. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Eyes • Medical Conditions of the Eye – Retinal detachment Shadow or blindness in part of visual field of affected eye. Treated surgically. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • • • • Organ of sound. Sound waves from environment. Processes for interpretation by brain. Plays important role in balance and equilibrium. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • The External Ear – Pinna collects sound waves; directs into external auditory canal through external auditory meatus to contact tympanic membrane. – External auditory canal extends to tympanic membrane. – Canal contains protective substance cerumen (earwax). ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear anatomy. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • The Middle Ear – Auditory ossicles: three small bones joined together; amplify sound waves received by tympanic membrane. – Bones: malleus, incus, stapes. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • The Middle Ear – Protected within tympanic cavity; connected to pharynx by Eustachian (auditory) tube. – Equalization of pressure between middle ear and environment. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • The Inner Ear – Separated from middle ear by oval window. – Hearing and equilibrium provided by specialized receptors within inner ear. – Protected by bony labyrinth. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • The Inner Ear – Bony labyrinth surrounded by collection of tubes and chambers (membranous labyrinth). – Membranous labyrinth filled with fluid (endolymph). ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • The Inner Ear – Vestibule: membranous sacs; sense gravity and linear acceleration. – Semicircular canals: sensory structures detect rotation of head. – Cochlea: spiral-shaped structure; contains cochlear duct of membranous labyrinth; receptors provide sense of hearing. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Internal ear anatomy. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Foreign body in external auditory canal not uncommon; children—especially toddlers. – Placed voluntarily; can be insects. – Painful; bleeding. – Removed with gentle suction or small forceps; magnets; irrigated with warm water. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Foreign body: insect within ear can cause trauma and infection. – Difficult to remove; fill external auditory canal with mineral oil; will suffocate insect. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Impacted cerumen: cerumen protects ear by trapping dust. – Excess blocks external auditory canal; interferes with hearing. – Symptoms: earache, ear plugging, tinnitus, hearing loss. – Plug removed: mineral or baby oil, drops, detergents, hydrogen peroxide. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Infections: common; particularly children. – Otitis externa (swimmer's ear): inflammation, irritation, infection of outer ear and/or external auditory canal. – Symptoms: pain, drainage, itching of ear or ear canal, hearing loss. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Infections (otitis externa) Treatment: analgesia, topical otic antibiotics, anti-inflammatory drugs. Malignant otitis external: infection of external ear; spreads to bones and cartilage at base of skull. Caused by difficult-to-treat bacterial infections. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Malignant otitis external Signs and symptoms: earache, pain, drainage, fever, difficulty swallowing, loss of voice, facial weakness. Hospitalization; antibiotic therapy. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Otitis media Common condition; children. Blockage of Eustachian tube; increased fluid pressure within middle ear. Bacterial or viral infection. Signs and symptoms: earache, fullness or pressure, general malaise, hearing loss, fever, vomiting, diarrhea. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Otitis media Chronic middle ear infection: persists or recurs; places individual at risk of permanent ear damage. Antibiotics; requires placement of tympanostomy tubes to decompress middle ear. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Perforated tympanic membrane Delicate structure; separates external ear from middle ear. Membrane easily perforated or ruptured by trauma, foreign objects, infection. Decreased hearing, earache, drainage of blood or pus, noise or buzzing. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Perforated tympanic membrane Symptoms often begin acutely. In most instances, perforation will heal. Treatment: analgesia and strategies to prevent infection. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Perforated tympanic membrane. (Reproduced with permission from Otolaryngology Houston, www.ghorayeb.com) ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Mastoiditis: infection of mastoid bone at base of skull; infection spreads from middle ear to mastoid. Primarily affects children. Ear pain, drainage, hearing loss, erythema and tenderness over mastoid bone, headache, fever. Antibiotics; surgery. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Labrynthitis: swelling and irritation of inner ear. Occurs following middle ear infection or upper respiratory infection. Vertigo, involuntary eye movements, dizziness, loss of balance, nausea and vomiting, hearing loss, tinnitus. Treatment: symptomatic. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Ear • Medical Conditions of the Ear – Ménière's disease: inner ear; affects balance and hearing. Labyrinths within inner ear swollen. Signs and symptoms: begin acutely; vertigo and dizziness, severe nausea and vomiting, hearing loss unilateral. No known cure. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Nose • Anatomy and Physiology of the Nose – Organ of smell; filtering, warming, humidifying incoming air. – Sense of smell: receptors in olfactory region of upper part of nasal cavity. – When brain processes incoming signals, we smell. – Senses of smell and taste closely related. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Nasal anatomy. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Nose • Anatomy and Physiology of the Nose – Structures highly vascular. – Kiesselbach's plexus; 90% of nosebleeds. – Sinuses: air-filled cavities separated from nasal cavity by mucous membrane (maxillary, frontal, ethmoid, sphenoid). ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Sinus anatomy. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Nose • Medical Conditions of the Nose – Epistaxis is nosebleed. Secondary to minor irritations or upper respiratory infection. Not life threatening. Anterior bleeds from Kiesselbach's plexus. Posterior bleeds from blood vessels further back in nasal cavity. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Nose • Medical Conditions of the Nose − Eistaxis is nosebleed. Treatment: simple pressure, medications, cauterization, pinching nose, catheters, nasal tampons Pain, nausea, vomiting may be present. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Nose • Medical Conditions of the Nose − Foreign body Common; especially in pediatric patient. Toys, beads, small rocks, food items. Whistling with respiration; pain, infection. Treatment: removal of foreign body. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Nose • Medical Conditions of the Nose − Rhinitis: inflammation of nose. Upper respiratory infection; allergies and similar conditions. In infants, treated with humidification of air, saline nose drops, bulb suctioning. Nasal decongestants, antihistamines, nasal corticosteroids. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Nose • Medical Conditions of the Nose − Sinusitis: infection or inflammation of sinuses; bacterial, viral, allergies. Facial pressure, headache, sore throat, posterior nasal drip, cough, bad breath, loss of smell, malaise, fever. Antibiotics, decongestants, antihistamines, corticosteroids. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Anatomy and Physiology of Mouth and Throat – Opening to oral cavity; entrance to gastrointestinal tract. – Conduit for respiratory gases. – Senses and analyzes substances before swallowing, mechanically processes food, enhances digestion. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Anatomy and Physiology of Mouth and Throat – Labia (lips) – Palate – Tongue – Pharynx – Uvula ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Oral cavity anatomy. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. The tongue. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Anatomy and Physiology of Mouth and Throat – Tonsils and adenoids – Teeth – Salivary glands – Esophagus – Larynx ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Pharyngitis/tonsillitis Infection of pharynx: pharyngitis. Infection of tonsils: tonsillitis. Viral or bacterial causes. Red and swollen throat, pus. Enlargement and tenderness of anterior nodes, headache, neck pain, nausea, vomiting. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Pharyngitis/tonsillitis Viral infections resolve with symptomatic treatment. Bacterial infections (strep throat): antibiotics. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Oral candidiasis (thrush) Fungal (yeast) infection of mouth. Infants, diabetics with poor glucose control, AIDS patients, side effect to antibiotics. White- or cream-colored deposit on mucous membranes; oral mucosa may be erythematous and swollen. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Oral candidiasis (thrush) Treatment: removing offending agent, correcting risk factors, use of antifungal agents. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Peritonsillar abscess Collection of infected material (pus) in area around tonsils. Complication of tonsillitis in children, adolescents, young adults. Treatment: antibiotics. Roof of mouth, neck, chest, lungs. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Peritonsillar abscess Swollen tissues may block airway, which is life-threatening medical emergency. Chills, difficulty opening mouth and swallowing, drooling, inability to swallow saliva, facial swelling, fever, headache, muffled voice, sore throat, tender glands of jaw and throat. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Peritonsillar abscess Treatment: drainage of abscess, antibiotics. Ensure airway protection and treatment of hypoxia. Self-suction with Yankauer suction tip. Pain and nausea: analgesics and antiemetics may be indicated. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Ludwig's angina Oral bacterial cellulitis (inflammation); floor of mouth under tongue. Occurs after infection of roots of teeth (dental abscess) or mouth injury. Develops quickly; swelling can occlude airway. Can be life threatening. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Ludwig's angina Breathing difficulty, confusion or mental changes, fever, neck pain and swelling, redness of the neck, weakness, fatigue, excess tiredness, difficulty swallowing, drooling, earache, speech that sounds like person has "hot potato" in mouth. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Ludwig's angina In severe cases, surgical airway (cricothyrotomy) may be required. Cured with proper protection of airways; appropriate antibiotics. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Dentalgia and dental abscess Result of lack of preventive dental care, restorative care, trauma. Non-life-threatening emergencies. Dental pain (dentalgia): exterior of tooth broken down, allowing sensitive interior structures (nerve) to be exposed. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Dentalgia and dental abscess In infection, development of closed-space infections (abscesses) causes pain; usually seen at gum line. Alleviation of pain, treat infection, dental care. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Foreign body Lodged in mouth/throat; can obstruct airway. At risk: children, psychiatric patients and prisoners, patients who do not have natural teeth. Ensure proper airway; transport to facility where foreign body can be removed. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Epiglottitis Inflammation or infection of epiglottis; can be life-threatening emergency. Fever, sore throat, drooling, stridor, hoarseness, difficulty breathing, cyanosis. Protect airway; antibiotics. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Laryngitis Swelling and inflammation of larynx. Viral infection or drainage from upper airway/sinus infection. Allergies, bacterial infections, injury, chemical exposures, gastroesophageal reflux disease (GERD), pneumonia. Fever, hoarseness, loss of voice. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Tracheitis Inflammation or infection of trachea. Bacterial infection; deep cough, dyspnea, fever, stridor. Patient may be hypoxic. Prevent airway obstruction; ventilate patient. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Throat • Medical Conditions of Mouth and Throat – Temporomandibular joint (TMJ) Problems with joint between temporal bone and mandible (jaw). Malocclusion of teeth; orthodontic appliances. Difficulty and pain in biting or chewing, clicking or popping of TMJ joint, dull facial pain, earache, jaw pain, headache. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Summary • There will be instances during your career as paramedic when you encounter patients with nontraumatic conditions involving the ears, eyes, nose, mouth, throat, and associated structures. • Some may be life threatening. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Summary • Prehospital treatment priorities: – Protection of airway, ventilation (if required), circulation. – Once established, try to identify cause of problem and begin appropriate treatment. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Summary • In many instances, treatment is symptomatic. • Pain treated with appropriate analgesic; nausea and vomiting treated with appropriate antiemetic. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed. Summary • Other issues treated as directed by local protocols. • Many nontraumatic conditions involving the ears, eyes, nose, mouth, and throat can be true emergencies; prompt recognition and treatment essential. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4th Ed.