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I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

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To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Saturday, 24 August 2019

Ear Problems

Otitis Media
Any upper respiratory tract infection (often bacterial - strep) but may be viral can cause inflammation of the respiratory mucosa, with obstruction of the eustacian tube isthmus, with results in accumulation of middle ear secretions. This causes negative pressure which pulls viruses and bacteria into the middle ear.
This increases the pressure causing otalgia and a bulging TM - the most obvious sign.
75 - 80% resolve by 72 hours - most are better by 3 days.

It is frequently overdiagnosed.

Complications include hearing loss, recurrent otitis media, perforation, labyrinthitis, mastoiditis, facial palsy, meningitis, cerebral abscess and venous sinus thrombosis.

Treatment is mostly with time. Watch and wait antibiotics may be useful.
Amoxicillin is the first choice if antibiotics actually needed (bilateral infection, longer than 3 days, systemically poorly)

There may be an associated effusion (glue ear). Consider a hearing assessment especially if recurrent.

Otitis Externa
This is often caused by bacteria and fungi, and less commonly viruses. The ear canal is swollen and sore with discharge- like a pimple. If there's mucous there, the discharge is probably from AOM. Treat with drops - antiseptic (acetic acid) and antibiotic (ciprofloxacin or aminoglycoside if no TM rupture).

Malignant Otitis Externa
Very painful and often in the elderly. Caused by pseudomonas.

Foreign Bodies in the Ear
Read this RCEMLearning article.

Nose Trauma
Nose trauma is common in children. There is a belief that nasal septal haematomas are more common - look for a cherry red haematoma in the nose.

https://www.rcemlearning.co.uk/foamed/stuck-in-the-ear/
https://journalfeed.org/article-a-day/2017/wait-and-see-antibiotics-for-otitis-media
https://dontforgetthebubbles.com/otitis-media/
https://www.nice.org.uk/guidance/ng91
https://www.rcemlearning.co.uk/foamed/stuck-in-the-ear/
https://www.gpnotebook.co.uk/simplepage.cfm?ID=-1241120761
http://dontforgetthebubbles.com/otitis-externa/
https://emedicine.medscape.com/article/845525-overview
https://www.bmj.com/content/349/bmj.g6075

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