Nasal foreign bodies are surprisingly common. The technique is not too dissimilar to that of removing auricular foreign bodies. In theory, they might be hidden behind a turbinate and tricky to see - and therefore tricky to remove.
1. Mother's Kiss
This works in 60% of cases. Occlude patent nostril. Get Mum to blow into the mouth. You can do this with a BVM if needed - but be careful the pressure isn't too high.
2. Suction
Like with FBs in the ear, gentle suction, can help. I guess glue could too - although I haven't seen any case reports of this.
3. Curved Needles
If you can't find one, as we can never find them in the ED, bend a green needle, and that should help!
4. Foley Catheter
Inflate baloon with 0.5 - 3ml water or air. Insert it behind the foreign body, and then pull. I've never tried this, but it seems to be really frequently used outside the UK!
References
http://journals.lww.com/em-news/blog/M2E/Pages/post.aspx?PostID=17
http://www.emdocs.net/ear-nose-throat-foreign-bodies/
https://wikem.org/wiki/Nasal_foreign_body
http://pmj.bmj.com/content/76/898/484
http://epmonthly.com/article/how-to-remove-a-nasal-foreign-body-with-a-balloon-catheter/
https://lifeinthefastlane.com/nasal-foreign-bodies/
http://www.racgp.org.au/download/Documents/AFP/2013/May/201305handi.pdf
http://emedicine.medscape.com/article/763767-overview?pa=kFsFTvrB8j%2FPtwK%2BOEAs61ub09VNBtvaAN6mPVwMp%2FDFndF9mwj4ym0rESwqOfDUa5AxknqcRm1Zi18mAza%2B0XnZ5j5IICuJuaa3Z%2BY2XGY%3D#a4
Showing posts with label PEMP9. Show all posts
Showing posts with label PEMP9. Show all posts
Thursday, 6 July 2017
Friday, 12 June 2015
Auricular Haematoma
Drainage of an auricular haematoma is one of the "new" practical procedures that has popped up on our e-portfolio. This is difficult to get signed off because there are minimal resources on it, and it's not a skill I've ever seen performed in the ED. I'm not sure if it's because I'm missing them, and not looking hard enough for them, or if it quite simply isn't a procedure we do in the ED. I've seen ear lacs and swollen ears - I must be missing something.
What is An Auricular Haematoma?
An auricular haematoma is a collection of blood that forms between the cartilage and the perichondrium of the ear. It is most often caused by blunt trauma to the ear.
Initial Treatment
Needle aspiration is often recommended. This failed in 75% of cases - maybe because the needle itself introduces haematoma.
Incision and Drainage
Incise along an anatomic crease to avoid a scar. Use forceps to encourage all of the haematoma out. Put a drain in, and then a dressing for compression. Prophylactic antibiotics have no evidence.
https://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=228
http://lifeinthefastlane.com/common-ear-complaints-in-the-ed/
http://journals.lww.com/em-news/Fulltext/2006/04000/Diagnosis__Traumatic_Auricular_Hematoma.20.aspx
http://www.epmonthly.com/departments/clinical-skills/visual-dx/how-to-treat-an-auricular-hematoma-in-the-emergency-department-photo-guide/
What is An Auricular Haematoma?
An auricular haematoma is a collection of blood that forms between the cartilage and the perichondrium of the ear. It is most often caused by blunt trauma to the ear.
Initial Treatment
Needle aspiration is often recommended. This failed in 75% of cases - maybe because the needle itself introduces haematoma.
Incision and Drainage
Incise along an anatomic crease to avoid a scar. Use forceps to encourage all of the haematoma out. Put a drain in, and then a dressing for compression. Prophylactic antibiotics have no evidence.
https://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=228
http://lifeinthefastlane.com/common-ear-complaints-in-the-ed/
http://journals.lww.com/em-news/Fulltext/2006/04000/Diagnosis__Traumatic_Auricular_Hematoma.20.aspx
http://www.epmonthly.com/departments/clinical-skills/visual-dx/how-to-treat-an-auricular-hematoma-in-the-emergency-department-photo-guide/
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