耳鼻咽喉科急症.ppt

耳鼻咽喉科急症Emergencies in ENT Epistaxis Trauma in ENT Laryngeal obstruction Foreign bodies in airway and esophagus All above are life-threatening 一、鼻衄 （Epistaxis） Terminology: Epistaxis Nosebleeding Introduction A very common sympton related to local or systemic causes. Mild to severe. Life-threatening in some cases 5-10% of the population experience an episode of epistaxis each year. 10% of those will see a physician. 1% of those seeking medical care will need a specialist. Usually unilateral (one side), rarely bilateral (both side) Anatomy and physiology of epistaxis Anatomy: nasal cavity (mucosa) vascular supply Physiology: vascular nature mucosa Common bleeding areas Anterior: Little’s area (Kesselbach’s plexus) younger, most common (90%), usually septal vs. anterior ethmoid, typically less severe Posterior: Woodruff’s plexus older population, more serious Other: usually occuring in trauma Etiology Local: Infectious/inflammatory Trauma/iatrogenic Neoplasm (benign or malignant) Anatomic causes (septal deviation) Physical or chemic (dessication, barotrauma, caustics) Etiology Systemic: Vascular: hypertension, arteriosclerosis, hereditary telangiectasia Coagulopathy: hematopathy, hepatic and renal diseases Infection: acute infectious diseases Etiology may relate to the age of the patient May not find out the causes in some cases (idiopathic) Disposal procedures ABC’s (airway, bleeding/breathing, circulation) Seeking the bleeding point/area Adopting efficacious treatment to control bleeding Looking up the causes of bleeding Methods Compression Cauterizing (silver nitrate, laser, radio-frequency or microwave) Nasal pack (anterior or posterior) Vascular ligation Selective angiography/emblization 严重后鼻出血的手术治疗方法 前-后鼻腔填塞术（Anterior