Bugs
The majority of acute otitis externa is caused by this organism.
Psuedomonas aeruginosa
This is first line antibiotic for AOM and the dosage for both children and adults.
Children: Amoxcillin 80mg/kg per day divided twice a day x 5 to 10 days
Adults: 875mg twice a day or 500mg three times a day for 5 to 7 days
These are things a patient can do to help prevent acute otitis externa
aural hygiene
dry ear after swimming
otc products or drops with alcohol or vinegar are available if the TM is intact.
This is where the vast majority of nose bleeds originate.
What is Kiesselbach's plexus
This bone behind the auricle should always be palpated and document nontenderness in the chart.
What is the mastoid bone
For patients exhibiting symptoms of otitis media with associated purulent conjunctivitis, this is the most common pathogen and we should consider using this medication.
H. influenzae
Augmentin
These two drops are approved for use in the middle ear (ie patients with TM tubes or ruptured TM)
ofloxacin
ciprodex
Your patient has been treated for epistaxis with anterior packing. You have completed procedure and patient is in no acute distress, VSS, you are ready to discharge. These 3 pearls are discharge instructions you provide for the patient.
Begin on Antibiotic, Return within 72 hours for packing removal (referred to ENT generally), Use nasal saline frequently and use ayr gel or emollient twice daily. cough and sneeze with your mouth open to prevent extra pressure on nares, don't take aspirin, don't pick or blow nose, don't remove packing on their own.
(make sure you educate patients on when to return if new bleeding, ie bright red blood dripping from nostril or in posterior pharynx, cotton and packing will weep when wet make sure you distinguish from new blood)
The first two methods to to try when attempting to stop a nose bleed are.
What is holding pressure, and apply ice cold cotton or cotton soaked with afrin.
These are three symptoms most often associated with bacterial sinusitis.
Fever.
Facial pain or pressure above or below one eye.
thick foul discharge.
Your patient presents with a moth/bug in the ear, and it is still alive. You should put this into the canal before attempting to remove it.
This is the antibiotic prescribed for sinusitis in patients allergic to penicillin.
Doxycycline
(alternatively may consider bactrim, cephalosporins / macrolides)
When the canal is so swollen you are concerned drops may not enter, this treatment option should be considered.
wick for external auditory canal and oral antibiotics.
The correct position of the nares when attempting to visualize.
What is parallel to the floor
Otic solution vs suspension in a patient with TM perforation or tubes?
Suspension, the lower pH is less likely to burn
This is the treatment for a patient with otomycosis
clotrimazole drops
This medication is often used with rhinosinusitis, working to prevent influx of neutrophils and making the mucosa inhospitable for mast cells.
Nasal Steroid Sprays
Patients with this condition will often present with complaints of ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, fluctuating conductive hearing loss, tinnitus.
Eustachian Tube dysfunction
These two products can be used if nasal tampon is not available in clinic.
What are xerofoam guaze(vasoline guaze) or plain packing strips coated with bacitracin.
*Freebie*
coffee or tea?
The four common pathogens of AOM
S. Pneumonia
H. Influenzae
M. catarrhalis
Grp A Strep
These medications can cause possible BP elevation, jitteriness, palpitations, insomnia and should be avoided in patients with prostate issues, narrow angle glaucoma, ischemic heart disease or hyperthyroidism.
Decongestants
This medication should not be used more than 72 hours as it can cause rebound congestion.
Afrin
These should be prescribed with any patient whose nasal cavity is packed.
Patient's with this packing are typically admitted to the hospital, especially if they have any other comorbid conditions.
What is bilateral nasal packing.
(bilateral nasal packing can cause damage to the nasal turbinates secondary to necrosis of mucosal tissue)