LAS VEGAS—A patient comes into the emergency department with a sore throat that turns out to be a peritonsillar abscess (PTA). Another presents with a dislocated jaw that needs to be rolled, pushed, or popped back into place. A third has a neck so swollen, Ludwig’s angina rushes to mind.
In many places that don’t have otolaryngologists on staff—and many that do—it’s up to the emergency physician to deal with all of it. So don’t be nervous.
“Many of us don’t like to deal with ENT emergencies…it’s scary and it’s messy and there’s a potential risk for complications,” said Teresa Wu, MD, FACEP, who presented “Nightmare ENT Emergencies: The Good, The Bad, & The Really Ugly.” But “don’t be afraid of these emergencies,” she said. “The more you take care of them, better you will be.”
Take dislocated jaws. There are myriad ways to treat. Standing in different positions for leverage is one tip. Putting a syringe between the patient’s teeth and having them roll it back and forth could do the trick. Sometimes, gagging the person can solve the issues.
Another common presentation is PTA. Years ago, CT scans were often used to first determine more about the issue. But with the advances of technology, emergency physicians like Dr. Wu recommend point-of-care ultrasound.
And practitioners and session attendees like Johnna Jaynstein, PA-C, who practices at Denver Health, are following the advice.
“I love the ultrasound component because it decreases risks, especially with those peritonsillar abscesses we see all the time,” she said. “Our department is not currently using tons of ultrasounds…so it will be something coming down the pike for us, which we’ve been very excited about.”
Dr. Wu, director of the emergency ultrasound program and fellowships at Banner University Medical Center and the simulation curriculum director and an associate professor in emergency medicine University of Arizona College of Medicine, all in Phoenix, said that using an ultrasound probe and following up with aspiration has its own nuanced process that emergency physicians must manage alongside the patient. Dr. Wu likes to have the patient hold on to something, say a suction tube, to feel part of the process and like they have some sense of control.
“Imagine they’re sacred, they don’t know what’s going on,” she added. “Their throat hurts. You’re telling them that you’re going to stick this probe into their mouth and you’re going to be sticking a needle in there as well. You need to involve them.”