I&D, clindamycin or augmentin outpatient, Unasyn inpatient
Dental abscess
Pain, tooth elevation, tenderness and swelling around tooth
CT if concerned for deeper abscess
Nsaids, opioids or local anesthetics, Dental follow up within 48 hrs, can do I&D
Augmentin, clindamycin, or Unasyn
Dacrocystitis
Infection of lacrimal sac due to blocked lacrimal duct
Swelling erythema and edema between medial canthus and nasal bridge
Manage with PO clindamycin, warm compresses, decongestants
Hordeolum (stye)
Blockage and infection of sebaceous/sweat glands of eye
Pustule with pain on eyelid
Treat with warm compresses
Blepharitis
Bacterial infection of meibomian gland
Swelling and erythema with pain and itching
Treat with hygiene, warm compresses, can use topical bacitracin
Prespetal and orbital cellulitis
Fever, Eyelid swelling and erythema with both
Orbital cellulitis will have visual defects, proptosis, and pain with EOM
Preseptal cellulitis is usually staph/strep, treat with Bactrim AND amoxicillin (or cefpodoxime or cefdinir)
Admit orbital cellulitis, treat with vanc/Unasyn (or vanc/zosyn), add ampho B for fungal infections if dm or immunocompromised
Herpes zoster ophthalmicus
Fever, headache, Hutchinson sign (vesicles on tip of nose)
Slit lamp
Artificial tears, topical abx to prevent secondary infection, antiviral
Gonorrheal conjunctivitis vs chlamydial conjunctivitis
3-5 days post partum for gonorrheal, 5-12 days is chlamydial
Topical erythromycin
Adults treated with azithro/ceftriaxone
Temperomandibular disorder (TMJ)
Pain for 3+ months in TMJ
Managed with Nsaids, can use muscle relaxers, soft food diet
f/u with dentistry
mandibular dislocation
typically anterior, typically atraumatic
clinical diagnosis
CT face / IAC/temp bone if concerned for posterior dislocation especially if traumatic
Evaluate cranial nerves
Reduce by translating inferiorly and posteriorly
Can try syringe technique (97% success)
Discharge if uncomplicated otherwise
Dr. Aiello and Dr. Kushner
Septal hematoma
Clinical diagnosis. Collection of blood will lead to infection, septal perforation, saddle nose deformity.
Use 4% lidocaine cotton balls (can use oxymetazolone) and plug both nares for 5-10 min
Incise vertically, stagger incision if bilateral
Pack with sponge/tampon
d/c with abx and analgesics, f/u with ENT in 2 days
Auricular Hematoma
Can lead to chronic ear deformity if not expressed/drained
Auricular block
Superficial incision
Pressure bandage to prevent reaccumulating
Trachs, with Dr. Perling and Dr. Marks
Tracheostomy done for upper airway obstructions, or patients on prolonged mechanical ventilation.
3-7 days for severe closed head injuries
Respiratory distress pathways and bleeding trachs
Most commonly trach fracture, displacement, obstruction, stenosis
Give O2 to stoma and mouth, remove inner canula, suction/confirm airway, confirm if trach patent or not. Bougie and re-trach, prepare to intubate from above
Tracheal infections = surgical consultation
Bleeding trach should raise concern, especially within 6 weeks
Beware sentinel bleeds
If bleeding; CUFFED tracheostomy
Manual compression if this fails.
CTA neck/chest
Buprenoprhine with Dr. Eisenstat
X waiver -> now MATE
Methadone and other maintenance therapies reduce overdose, comorbidities of OUD
It is meant to be bridging, not long term alternative
Methadone = full agonist, long acting, but must go get it daily. Also QT prolonging
Bazett formula for QTc : QT/ (sqrt of) RR interval
Buprenorphine = extremely competitive agonist, can precipitate withdrawal
Suboxone = buprenorphine with naloxone (to prevent abuse)
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