Emergency Care and Acuity Levels Quiz

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Questions and Answers

What are the primary symptoms of auricular hematoma?

Protrusion of the auricle and tenderness (correct)

Fluid drainage from the ear

Increased earwax production

Severe itching in the ear canal

Which of the following is a common risk associated with untreated auricular hematoma?

Formation of deep tissue infections

Complete loss of the ear

Development of a 'cauliflower ear' deformity (correct)

Increased hearing loss

When is urgent removal of a foreign body in the ear most necessary?

For live insects and button batteries (correct)

For a piece of cotton

For small toy parts

For rolled up paper

What is a primary risk factor for cartilage necrosis associated with auricular hematoma?

Separation from vascular supply Signup and view all the answers

Which symptom can be associated with both TM perforation and cerumen impaction?

Decreased hearing Signup and view all the answers

Which treatment is NOT recommended for cerumen impaction?

Use of skin glue Signup and view all the answers

What symptom is classically associated with Central Retinal Vein Occlusion during a fundoscopic exam?

Diffuse retinal hemorrhages Signup and view all the answers

Which one of the following presentations is typical of retinal detachment?

Monocular, painless vision loss resembling a curtain Signup and view all the answers

What should be documented regarding a tympanic membrane perforation?

Perforation size as a percentage Signup and view all the answers

What is a potential complication of retinal vein occlusion known as '90 day glaucoma'?

Elevated IOP with pain Signup and view all the answers

What is a recommended method for draining an auricular hematoma?

Incision and drainage followed by a pressure dressing Signup and view all the answers

What is the primary treatment required for orbital cellulitis?

IV antibiotics and hospital admission Signup and view all the answers

What symptom may indicate the progression of retinal detachment?

Floaters or flashers prior to vision loss Signup and view all the answers

Which of the following is a specific sign of orbital cellulitis?

Proptosis and diplopia Signup and view all the answers

What is a key risk factor for retinal detachment?

History of myopia or cataract surgery Signup and view all the answers

Which of the following findings is not typically associated with Central Retinal Vein Occlusion?

Pale retina Signup and view all the answers

What is a common initial treatment for corneal ulcers?

Topical antibiotics such as ciprofloxacin or ofloxacin Signup and view all the answers

Which pathogens are commonly associated with corneal ulcers in contact lens wearers?

Pseudomonas, Staphylococcus aureus, and Streptococcus pneumoniae Signup and view all the answers

What may the examination reveal in a patient with a corneal ulcer?

Hazy-based ulcer extending into the stroma Signup and view all the answers

Which of the following is a hallmark symptom of necrotizing otitis externa?

Severe otalgia and purulent otorrhea Signup and view all the answers

In necrotizing otitis externa, what is the most likely causative organism?

Pseudomonas aeruginosa Signup and view all the answers

What imaging study is often utilized to diagnose necrotizing otitis externa?

CT scan of the head with contrast Signup and view all the answers

What would be an appropriate treatment option for acute mastoiditis?

Intravenous antibiotics such as cefepime or piperacillin-tazobactam Signup and view all the answers

What is a common complication of acute otitis media?

Acute mastoiditis Signup and view all the answers

What acuity level is assigned to patients requiring immediate life-saving intervention?

1 Signup and view all the answers

What is the first step in managing a mass casualty incident (MCI)?

Global sorting based on patients' ability to follow commands Signup and view all the answers

Which of the following is a common site for an orbital blow-out fracture?

Inferior wall (maxillary sinus) Signup and view all the answers

Which emergency management action should be taken for a chemical ocular injury with alkali?

Irrigate with normal saline Signup and view all the answers

What is a potential consequence of orbital hemorrhage?

Limited extraocular movements Signup and view all the answers

Which symptom is commonly associated with a fracture of the inferior wall of the orbit?

Diplopia on upward gaze Signup and view all the answers

What is the primary reason why alkali chemical injuries are more damaging than acid injuries?

They lead to liquefaction necrosis. Signup and view all the answers

What precaution should be advised after managing a minor blowout fracture?

Caution against nose blowing. Signup and view all the answers

What is a common treatment for chronic sinusitis?

Nasal saline and oral steroids Signup and view all the answers

Which symptom would most likely indicate strep throat rather than a viral infection?

Fever and tonsillar exudate Signup and view all the answers

Which characteristic is NOT typical of pit vipers?

Round pupils Signup and view all the answers

What is the primary diagnostic test for streptococcal pharyngitis?

Rapid strep swab Signup and view all the answers

What type of venom effects are primarily associated with pit viper bites?

Cytotoxic effects Signup and view all the answers

What might develop if strep throat is not treated adequately?

Cardiac complications Signup and view all the answers

Which of the following best describes an envenomation from pit vipers?

Primarily affects the bite area with pain and swelling Signup and view all the answers

What is NOT a recommended management strategy for snake envenomation?

Apply a tourniquet Signup and view all the answers

Study Notes

Acuity Levels

Acuity Level 1: Immediate life-saving intervention required (e.g., cardiac arrest, severe trauma)
Acuity Level 2: High risk for deterioration or severe pain/distress (e.g., chest pain, sepsis)
Acuity Level 3: Stable but require multiple resources (e.g., abdominal pain, fractures)
Acuity Level 4: Stable and need one resource (e.g., simple laceration needing stitches)
Acuity Level 5: Stable and need no resources beyond physical exam (e.g., minor colds)

Mass Casualty Incident (MCI)

MCI: Prioritizing victims when resources are insufficient
Sorting begins with global sorting based on patients' ability to follow commands
Provide basic life-saving interventions (e.g., airway, breathing, circulation)
Lower acuity patients can be managed outpatient, but consult with specialists first

Orbital Blow-Out Fractures

MC sites: Inferior wall (maxillary sinus) & medial wall (ethmoid sinus)
Examine for trauma, visual acuity, palpation of the face, and pupils
Diplopia on upward gaze common with inferior wall fracture due to inferior rectus and oblique entrapment
Maxillofacial CT required for diagnosis
Refer to Ophthalmology or Maxillofacial surgery
Minor fractures can be managed outpatient
Prophylactic cephalexin and caution on blowing nose

Orbital Hemorrhage

Can lead to blindness
Limited extraocular movements
Lateral canthotomy (incision through the lateral canthus) allows the globe to stand out and relieve pressure
Ischemia to the optic nerve

Chemical Ocular Injury

Alkali (e.g., ammonia, lye) injuries are worse than acid injuries
Irrigate with 1-2 liters of normal saline using a Morgan's lens until pH is less than 7.4
Exam includes pH measurement, slit lamp exam, and IOP assessment

Central Retinal Artery Occlusion

Stroke equivalent with similar risk factors
Acute, painless, monocular vision loss with poor visual acuity
Fundoscopic Exam: afferent pupillary defect, pale retina with cherry red macula, "boxcarring" of retinal vessels
Macula is still red due to choroid circulation
Treatment may involve a thrombolytic
Ophthalmology and Stroke Neurology consultation

Central Retinal Vein Occlusion

Thrombosis of the central retinal vein causing retinal venous stasis, edema, and hemorrhage
Acute, subacute, or progressive, painless monocular vision loss
Fundoscopic exam: Diffuse retinal hemorrhages ("blood and thunder"), optic disc edema, dilated retinal veins, cotton wool spots
Afferent pupillary defect
Elevated IOP with pain is a late finding ("90 day glaucoma")

Retinal Detachment

Separation of the retina from the retinal pigment epithelium and choroid
Monocular, progressive, painless vision loss resembling a curtain over the field of vision
Fleeting "flashers" and/or "floaters" may precede detachment
Increased risk with myopia or cataract surgery
Diagnosis is clinical
POCUS: Billowing hyperechoic line that waves with eye movement
Decrease eye movement (no reading, watching television, or exercising)
Ophthalmologist consultation/referral

Orbital Cellulitis

Infection of the orbital soft tissues posterior to the orbital septum
Potentially life-threatening and requires hospital admission and IV antibiotics
Etiologies: bacterial rhinosinusitis, orbital trauma, ocular surgery
Pain with extraocular movements is specific to Orbital Cellulitis
Visual disturbance, diplopia, ophthalmoplegia, proptosis, and afferent pupillary defect may be present
Treatment: Oral acyclovir or valacyclovir, possibly steroids. Immunocompromised patients may require IV antivirals
Consult

Corneal Ulcer

Serious infection affecting multiple corneal layers following epithelial damage
Typical symptoms: Eye redness, lid and conjunctival swelling, discharge, pain, foreign body sensation, photophobia, and blurred vision
Examination reveals a round or irregular hazy-based ulcer extending into the stroma with possible iritis
Slit-lamp findings: Cells and flare from iritis, hypopyon
Treatment: Topical antibiotics (e.g., ciprofloxacin, ofloxacin)
Ophthalmologic consultation for culture and appropriate antibiotic therapy
Cycloplegics may be used to ease iritis-related pain

Necrotizing (Malignant) Otitis Externa

Invasive infection of the ear canal spreading through the periauricular tissue to the mastoid/temporal bone
MC causative organism: Pseudomonas
More common in elderly, diabetic, and immunocompromised patients
Presentation: Non-resolving OE, severe otalgia, edema/erythema/warmth of the external auditory canal, purulent otorrhea, tenderness of the mastoid/temporal bone with palpation
Raised concern for: Cranial nerve palsies (facial nerve MC), parotitis, trismus
Diagnosis: Maxillofacial/temporal and head CT with contrast, blood cultures, ear drainage culture, CRP/ESR
Treatment: Oral vs IV fluoroquinolones (Ciprofloxacin) or antipseudomonal beta-lactams (cefepime, piperacillin-tazobactam)
Consult ENT

Acute Mastoiditis

Suppurative infection of the mastoid air cells, a complication of acute otitis media
MC pathogens: S.pneumoniae, Streptococcus pyogenes, P.aeruginosa
Presentation: Protrusion of the auricle, obliteration of the postauricular crease, postauricular/mastoid erythema, edema, and tenderness
Clinical diagnosis
Imaging: Head CT with contrast
Treatment: Ceftriaxone or levofloxacin
Consult/refer to ENT. May require surgical intervention.

Auricular Hematoma

Caused by blunt, shearing force separating the cartilage from its vascular supply
Hematoma forms between the cartilage and perichondrium
Risk of cartilage necrosis and scarring: Cartilage loses its nutrient and vascular supply
Fibrocartilaginous overgrowth: "Cauliflower ear" deformity
Treatment: Drainage with needle or incision, followed by pressure dressing
Re-evaluate in 24 hours for re-accumulation
Avoid drainage if there is concern for neurovascular compromise to the ear
Consult ENT or Plastics

Ear Foreign Body

Urgent removal is required for live insects, button batteries, or penetrating injuries to the tympanic membrane
Consider ENT consultation for button batteries and penetrating TM injuries
Non-emergent removal methods: Irrigation, suction, skin glue, magnet, alligator forceps
Examine the ear canal and TM carefully after removal

Cerumen Impaction

Common symptoms: Decreased hearing, pressure/fullness in the ear, otalgia, dizziness, tinnitus
Treatment: Soften wax with hydrogen peroxide, Debrox, or liquid docusate (Colace), then irrigate
Removal: Ear loop/curette
Risk of TM perforation: Previous ear surgery, current or previous OM or OE
Call ENT if needed

TM Perforation

Acute onset of pain and hearing loss with or without bloody otorrhea
Transient vertigo or tinnitus may occur
Etiologies: Secondary to AOM, barotrauma, trauma
Document perforation size in percentage relative to the total TM
Chronic symptoms: Last longer than 12 days

Sinusitis

Painful, tender sinuses
Fever
Sinuses cannot be transilluminated
Dx: X-ray (Waters view), CT scan if chronic

Sinusitis Treatment

Nasal saline
Humidifier
Antibiotics: Bactrim, Augmentin
Oral steroids: Prednisone
Nasal steroids: Flonase
Expectorants: Guaifenesin, Mucinex (drinking fluids)

Pharyngitis

Strep Throat: Sore throat, odynophagia, no cough
PE: Fever, tonsillar exudate, edema and erythema, cervical lymphadenopathy
Dx: Rapid Strep Swab (obtain two swabs)
Tx: Antibiotics (amoxicillin, penicillin), saltwater gargles, benzocaine lozenges

Envenomation

Presence of snakebite plus evidence of tissue injury

Pit Vipers (Crotaline)

Heat-sensing pits: Located between eyes and nostrils, detect infrared radiation from warm-blooded animals
Triangular head shape: Wider than the neck
Vertical pupils: Elliptical, slit-like pupils
Fangs: Long, hollow, retractable fangs used to inject venom

Effects of Pit Viper Venom

Local Effects (Cytoroxic): Immediate pain, swelling, ecchymosis at the bite site. Swelling may rapidly progress and involve the entire limb, blistering, necrosis, hemorrhage.
Systemic Effects: May be observed minutes to hours after the bite, including hypotension, tachycardia, respiratory distress, neurological abnormalities, coagulopathy, and renal failure.

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Description

Test your knowledge on the acuity levels of medical emergencies, including Immediate life-saving interventions and Mass Casualty Incidents (MCI). Understand the priorities in treating patients with various conditions such as orbital blow-out fractures. This quiz is essential for anyone in the healthcare field.