Transcript Slide 1

Paramedic Care: Principles & Practice
Fourth Edition
Volume 4: Medicine
CHAPTER
12
Diseases of the
Eyes, Ears, Nose,
and Throat
Standard
• Medicine (Diseases of the Eyes, Ears,
Nose, and Throat)
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Competency
• Integrates assessment findings with
principles of epidemiology and
pathophysiology to formulate a field
impression and implement a
comprehensive treatment/disposition
plan for a patient with a medical
complaint.
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Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• Head and neck contain many of body's
essential sensory organs and important
structures.
• This chapter addresses nontraumatic
conditions of head and neck.
• Important structures: eyes, ears, nose,
throat, associated structures.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Eyes are organs of sight.
• Gather light and focus light onto
receptors in back of eye that produce
image interpreted by brain.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• External Anatomy of the Eye
– Protected by bones (ocular orbit).
– Orbit padded with subcutaneous tissue;
cushions and protects eye from injury.
– Movement of eyes controlled by six
extraocular muscle; allow us to look in
various directions.
– Two movable folds of skin (eyelids)
protect eyes from environment.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• External Anatomy of the Eye
– Eyelashes function as sensors to cause
rapid closure of eyelids when foreign
substance approaches eyes.
– Glands secrete oily substance (sebum)
onto eyelids to keep them soft and
pliable.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• External Anatomy of the Eye
– Membrane (conjunctiva) covers and
protects exposed surface of eye.
– Each eye has lacrimal apparatus;
manufactures and stores tears.
– Tears manufactured in lacrimal glands;
spread across eye where they drain
through lacrimal ducts into nose.
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Paramedic Care: Principles & Practice, 4th Ed.
External anatomy of the eye.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Internal Anatomy of the Eye
– Globe: two distinct fluid-filled cavities.
– Posterior cavity, portion of eye behind
lens, contains vitreous humor.
– Vitreous humor: clear, jellylike fluid that
fills entire vitreous cavity.
– Anterior cavity: portion of eye in front of
lens, contains aqueous humor.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Internal Anatomy of the Eye
– Aqueous humor: waterlike fluid that
surrounds iris, pupil, lens.
– Anterior cavity divided into anterior
chamber and posterior chamber.
– Both chambers filled with aqueous
humor.
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Eyes
• Internal Anatomy of the Eye
– Innermost layer: retina.
– Middle layer: choroid.
– Outermost layer: sclera.
– Sclera: tough, fibrous, protective tissue;
("whites of the eyes").
– Cornea: transparent, curved portion of
sclera; allows light to pass into eye and
onto retina.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Internal Anatomy of the Eye
– Choroid: highly vascular tissue;
provides essential nutrients to tissues of
eye; contains iris and pupil.
– Iris: colored portion of eye; controls size
of pupil; changes diameter of pupillary
opening.
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Eyes
• Internal Anatomy of the Eye
– Behind pupil is lens; focuses incoming
light images onto retina.
– Ciliary muscles surround lens; change
shape of lens to focus incoming image.
– Retina contains nerve endings; receives
and interprets incoming image.
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Eyes
• Internal Anatomy of the Eye
– Retina: contains two types of lightsensing receptors (rods and cones).
– Rods effective in dim light and do not
perceive color; cones more effective in
bright light and do perceive color.
– Chemical change sends impulses to
optic nerve and brain, where image
interpreted.
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Internal anatomy of the eye.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Sty(e) (external hordeolum)
 Infection of eyelid; blockage of oil glands
associated with eyelash.
 Located at lash line; small pustule/lump.
 Resolves when gland blockage relieved;
warm soaks, topical antibiotics.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Chalazion (internal hordeolum)
 Inflammation or infection; blockage of
meibomian glands in tarsal plate of
eyelid.
 Meibomian glands produce fluid that
lubricates eyelids.
 Red, tender lump in eyelid or margin.
 Treatment: similar to that for sty; may
require antibiotics.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Conjunctivitis
 Infection or inflammation of conjunctiva.
– Bacterial conjunctivitis ("pinkeye").
– Limited to conjunctiva; cornea is clear.
– Red and itching; more tears than usual.
– Treatment: topical antibiotics.
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Conjunctivitis. (© Dorling Kindersley)
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Eyes
• Medical Conditions of the Eye
– Conjunctivitis
 Infection or inflammation of conjunctiva.
– Viral conjunctivitis:similar to bacterial
conjunctivitis.
– Cause is viral.
– Treatment is symptomatic.
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Eyes
• Medical Conditions of the Eye
– Conjunctivitis
 Infection or inflammation of conjunctiva
– Allergic conjunctivitis: exposure to pollen
and antigens to which patient allergic.
– Redness, watery discharge, itching,
swelling.
– Tends to be seasonal; oral and topical
ocular antihistamines.
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Eyes
• Medical Conditions of the Eye
– Pterygium
 Conjunctival condition; raised, wedgeshaped growth of conjunctiva.
 Noncancerous; visible over white sclera.
 Common in people who have increased
outdoor exposure to sun, wind, dust.
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Eyes
• Medical Conditions of the Eye
– Iritis (uveitis)
 Swelling/irritation of middle layer of eye.
 Patients with autoimmune diseases.
 Anterior uveitis: inflammation of front
part of eye (iritis).
 Posterior uveitis: back part of choroid
(choroiditis).
 Can affect one or both eyes.
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Eyes
• Medical Conditions of the Eye
– Iritis (uveitis)
 Blurred vision, eye pain, erythema,
photosensitivity, floaters.
 Treatment: protection from light,
analgesia, corticosteroid eye drops.
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Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Herpes simplex virus (HSV) keratitis
 Infection and inflammation of cornea;
herpes simplex virus.
 Frequent cause of corneal blindness;
reason for corneal transplantation.
 Pain, photophobia, blurry vision, tearing,
erythema.
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Eyes
• Medical Conditions of the Eye
– Herpes zoster ophthalmicus
 Herpes zoster (shingles) affects eye.
 Virus spreads along first division of
trigeminal nerve.
 Damage can result to eye itself; ulcer or
similar lesion on cornea.
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Eyes
• Medical Conditions of the Eye
– Corneal ulcers
 Infection of cornea by infectious agent;
breaks through epithelial of cornea.
 Serious and sight-threatening infections.
 Painful red eye, tearing, photophobia.
 Viral infections treated differently than
bacterial infections.
 Evaluation by ophthalmologist essential.
©2013 Pearson Education, Inc.
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Eyes
• Medical Conditions of the Eye
– Cellulitis
 Soft tissues surrounding eye infected.
 Sight-threatening and life-threatening
condition.
 Periorbital cellulitis (preseptal): has not
breached orbital septum.
 Edematous, erythematous, warm eyelids
and surrounding tissues.
 Eye itself not involved.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Cellulitis
 Periorbital cellulitis (preseptal): usually
bacterial; risk for children.
 Pain, conjunctivitis, blurred vision,
increased tear production.
 Treatment: potent antibiotics; hospital
admission.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Cellulitis
 Orbital cellulitis (postseptal): serious
infection; structures behind orbital
septum.
 Complication of periorbital cellulitis and
sinus infections.
 Common in winter months.
 Fever, headache, eyelid edema, runny
nose, generalized malaise.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Cellulitis
 Orbital cellulitis (postseptal): protrusion
of eye; inability to move eye because of
infection and swelling.
 Pain with eye movement, decreased
vision, inflammation of conjunctiva.
 Requires hospitalization, potent
antibiotics, surgical drainage; true
emergency.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Hyphema
 Collection of blood in anterior chamber of
eye; result of trauma.
 Nontraumatic conditions: sickle cell
disease, diabetes, tumors of eye.
 Sight-threatening condition; evaluation
by ophthalmologist indicated.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Glaucoma
 Group of eye sight-threatening eye
conditions.
 Increase in pressure within eye
(intraocular pressure [IOP]).
 Damages optic nerve; second cause of
blindness in U.S.
 Blockage of flow of aqueous humor from
anterior chamber.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Glaucoma
 Angle-closure glaucoma: outflow of
aqueous humor suddenly blocked; causes
rapid and severe increase in IOP.
 Open-angle glaucoma: most common
type; IOP increases slowly over time.
 Places pressure on optic nerve and
retina; can lead to blindness.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Glaucoma
 Open-angle: no symptoms; begin to lose
vision.
 Angle-closure: develop severe pain in
affected eye; decreased or cloudy vision;
red and swollen; rainbow- or halo-like
effects around lights.
 Acute angle-closure: treatment is to
reduce IOP; medications or surgery.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Cataract
 Clouding of lens of eye.
 Associated with aging; breakdown of
proteins within lens.
 Risk factors: diabetes, eye injury,
radiation exposure, smoking, exposure to
ultraviolet light (sunlight).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Cataract
 Decreased vision, cloudy or fuzzy vision,
light sensitivity, diplopia, loss of color
intensity, halos around lights.
 Treatment: prevention; surgical removal.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Cataract. (National Eye Institute, National Institutes of Health)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Optic neuritis
 Inflammation of optic nerve.
 Result of autoimmune diseases;
infections, drug toxicity, multiple
sclerosis.
 Loss of vision in single eye in an hour;
loss of color vision, changes in pupillary
reaction to light, pain with eye
movement.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Optic neuritis
 Vision returns to normal within 2 to 3
weeks without treatment.
 Corticosteroids used.
 Ophthalmologic evaluation essential.
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Eyes
• Medical Conditions of the Eye
– Papilledema
 Not condition per se; swelling of optic
disc secondary to increased intracranial
pressure.
 Optic disc: region of retina where fibers
of optic nerve enter eye.
 Causes: trauma, infections within brain,
stroke, tumors, hydrocephalus.
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Eyes
• Medical Conditions of the Eye
– Central retinal artery occlusion
 Blockage of small arteries that supply
retina; results from thrombus or
atherosclerotic plaque.
 Common source of clots.
 Common in diabetics, patients with
arrhythmias, those with valvular heart
disease, intravenous drug abusers.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Central retinal artery occlusion
 Symptoms: involve all or part of one
eye; last from few seconds to minutes.
 Blockage can be permanent.
 Treatment: fibrinolytics; massaging eye.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Central retinal vein occlusion
 Blockage of small veins that drain retina;
caused by atherosclerosis or thrombus.
 Common in diabetics, hypertension,
atherosclerosis, other eye conditions
such as glaucoma.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Central retinal vein occlusion
 Symptoms: sudden blurring or vision loss
in all or part of one eye.
 Regain vision without treatment; rarely
returns to normal.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Retinal detachment
 Separation of retina from supporting
structures.
 Unknown causes; trauma, diabetes.
 Bright flashes of light in peripheral vision.
 Blurred vision; "floaters" in eye.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Eyes
• Medical Conditions of the Eye
– Retinal detachment
 Shadow or blindness in part of visual
field of affected eye.
 Treated surgically.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
•
•
•
•
Organ of sound.
Sound waves from environment.
Processes for interpretation by brain.
Plays important role in balance and
equilibrium.
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Paramedic Care: Principles & Practice, 4th Ed.
Ear
• The External Ear
– Pinna collects sound waves; directs into
external auditory canal through external
auditory meatus to contact tympanic
membrane.
– External auditory canal extends to
tympanic membrane.
– Canal contains protective substance
cerumen (earwax).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear anatomy.
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Paramedic Care: Principles & Practice, 4th Ed.
Ear
• The Middle Ear
– Auditory ossicles: three small bones
joined together; amplify sound waves
received by tympanic membrane.
– Bones: malleus, incus, stapes.
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Ear
• The Middle Ear
– Protected within tympanic cavity;
connected to pharynx by Eustachian
(auditory) tube.
– Equalization of pressure between middle
ear and environment.
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Paramedic Care: Principles & Practice, 4th Ed.
Ear
• The Inner Ear
– Separated from middle ear by oval
window.
– Hearing and equilibrium provided by
specialized receptors within inner ear.
– Protected by bony labyrinth.
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Ear
• The Inner Ear
– Bony labyrinth surrounded by collection
of tubes and chambers (membranous
labyrinth).
– Membranous labyrinth filled with fluid
(endolymph).
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Ear
• The Inner Ear
– Vestibule: membranous sacs; sense
gravity and linear acceleration.
– Semicircular canals: sensory structures
detect rotation of head.
– Cochlea: spiral-shaped structure;
contains cochlear duct of membranous
labyrinth; receptors provide sense of
hearing.
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Paramedic Care: Principles & Practice, 4th Ed.
Internal ear anatomy.
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Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Foreign body in external auditory canal
not uncommon; children—especially
toddlers.
– Placed voluntarily; can be insects.
– Painful; bleeding.
– Removed with gentle suction or small
forceps; magnets; irrigated with warm
water.
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Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Foreign body: insect within ear can
cause trauma and infection.
– Difficult to remove; fill external auditory
canal with mineral oil; will suffocate
insect.
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Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Impacted cerumen: cerumen protects
ear by trapping dust.
– Excess blocks external auditory canal;
interferes with hearing.
– Symptoms: earache, ear plugging,
tinnitus, hearing loss.
– Plug removed: mineral or baby oil,
drops, detergents, hydrogen peroxide.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Infections: common; particularly
children.
– Otitis externa (swimmer's ear):
inflammation, irritation, infection of
outer ear and/or external auditory
canal.
– Symptoms: pain, drainage, itching of
ear or ear canal, hearing loss.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Infections (otitis externa)
 Treatment: analgesia, topical otic
antibiotics, anti-inflammatory drugs.
 Malignant otitis external: infection of
external ear; spreads to bones and
cartilage at base of skull.
 Caused by difficult-to-treat bacterial
infections.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Malignant otitis external
 Signs and symptoms: earache, pain,
drainage, fever, difficulty swallowing,
loss of voice, facial weakness.
 Hospitalization; antibiotic therapy.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Otitis media
 Common condition; children.
 Blockage of Eustachian tube; increased
fluid pressure within middle ear.
 Bacterial or viral infection.
 Signs and symptoms: earache, fullness
or pressure, general malaise, hearing
loss, fever, vomiting, diarrhea.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Otitis media
 Chronic middle ear infection: persists or
recurs; places individual at risk of
permanent ear damage.
 Antibiotics; requires placement of
tympanostomy tubes to decompress
middle ear.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Perforated tympanic membrane
 Delicate structure; separates external ear
from middle ear.
 Membrane easily perforated or ruptured
by trauma, foreign objects, infection.
 Decreased hearing, earache, drainage of
blood or pus, noise or buzzing.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Perforated tympanic membrane
 Symptoms often begin acutely.
 In most instances, perforation will heal.
 Treatment: analgesia and strategies to
prevent infection.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Perforated tympanic membrane. (Reproduced with permission from Otolaryngology Houston,
www.ghorayeb.com)
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Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Mastoiditis: infection of mastoid bone at
base of skull; infection spreads from
middle ear to mastoid.
 Primarily affects children.
 Ear pain, drainage, hearing loss,
erythema and tenderness over mastoid
bone, headache, fever.
 Antibiotics; surgery.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Labrynthitis: swelling and irritation of
inner ear.
 Occurs following middle ear infection or
upper respiratory infection.
 Vertigo, involuntary eye movements,
dizziness, loss of balance, nausea and
vomiting, hearing loss, tinnitus.
 Treatment: symptomatic.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Ear
• Medical Conditions of the Ear
– Ménière's disease: inner ear; affects
balance and hearing.
 Labyrinths within inner ear swollen.
 Signs and symptoms: begin acutely;
vertigo and dizziness, severe nausea and
vomiting, hearing loss unilateral.
 No known cure.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nose
• Anatomy and Physiology of the Nose
– Organ of smell; filtering, warming,
humidifying incoming air.
– Sense of smell: receptors in olfactory
region of upper part of nasal cavity.
– When brain processes incoming signals,
we smell.
– Senses of smell and taste closely
related.
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Nasal anatomy.
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Nose
• Anatomy and Physiology of the Nose
– Structures highly vascular.
– Kiesselbach's plexus; 90% of
nosebleeds.
– Sinuses: air-filled cavities separated
from nasal cavity by mucous membrane
(maxillary, frontal, ethmoid, sphenoid).
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Sinus anatomy.
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Nose
• Medical Conditions of the Nose
– Epistaxis is nosebleed.
 Secondary to minor irritations or upper
respiratory infection.
 Not life threatening.
 Anterior bleeds from Kiesselbach's
plexus.
 Posterior bleeds from blood vessels
further back in nasal cavity.
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Nose
• Medical Conditions of the Nose
− Eistaxis is nosebleed.
 Treatment: simple pressure, medications,
cauterization, pinching nose, catheters,
nasal tampons
 Pain, nausea, vomiting may be present.
©2013 Pearson Education, Inc.
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Nose
• Medical Conditions of the Nose
− Foreign body
 Common; especially in pediatric patient.
 Toys, beads, small rocks, food items.
 Whistling with respiration; pain,
infection.
 Treatment: removal of foreign body.
©2013 Pearson Education, Inc.
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Nose
• Medical Conditions of the Nose
− Rhinitis: inflammation of nose.
 Upper respiratory infection; allergies and
similar conditions.
 In infants, treated with humidification of
air, saline nose drops, bulb suctioning.
 Nasal decongestants, antihistamines,
nasal corticosteroids.
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Nose
• Medical Conditions of the Nose
− Sinusitis: infection or inflammation of
sinuses; bacterial, viral, allergies.
 Facial pressure, headache, sore throat,
posterior nasal drip, cough, bad breath,
loss of smell, malaise, fever.
 Antibiotics, decongestants,
antihistamines, corticosteroids.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Anatomy and Physiology of Mouth and
Throat
– Opening to oral cavity; entrance to
gastrointestinal tract.
– Conduit for respiratory gases.
– Senses and analyzes substances before
swallowing, mechanically processes
food, enhances digestion.
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Throat
• Anatomy and Physiology of Mouth and
Throat
– Labia (lips)
– Palate
– Tongue
– Pharynx
– Uvula
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Oral cavity anatomy.
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The tongue.
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Throat
• Anatomy and Physiology of Mouth and
Throat
– Tonsils and adenoids
– Teeth
– Salivary glands
– Esophagus
– Larynx
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Throat
• Medical Conditions of Mouth and Throat
– Pharyngitis/tonsillitis
 Infection of pharynx: pharyngitis.
 Infection of tonsils: tonsillitis.
 Viral or bacterial causes.
 Red and swollen throat, pus.
 Enlargement and tenderness of anterior
nodes, headache, neck pain, nausea,
vomiting.
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Throat
• Medical Conditions of Mouth and Throat
– Pharyngitis/tonsillitis
 Viral infections resolve with symptomatic
treatment.
 Bacterial infections (strep throat):
antibiotics.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Oral candidiasis (thrush)
 Fungal (yeast) infection of mouth.
 Infants, diabetics with poor glucose
control, AIDS patients, side effect to
antibiotics.
 White- or cream-colored deposit on
mucous membranes; oral mucosa may
be erythematous and swollen.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Oral candidiasis (thrush)
 Treatment: removing offending agent,
correcting risk factors, use of antifungal
agents.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Peritonsillar abscess
 Collection of infected material (pus) in
area around tonsils.
 Complication of tonsillitis in children,
adolescents, young adults.
 Treatment: antibiotics.
 Roof of mouth, neck, chest, lungs.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Peritonsillar abscess
 Swollen tissues may block airway, which
is life-threatening medical emergency.
 Chills, difficulty opening mouth and
swallowing, drooling, inability to swallow
saliva, facial swelling, fever, headache,
muffled voice, sore throat, tender glands
of jaw and throat.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Peritonsillar abscess
 Treatment: drainage of abscess,
antibiotics.
 Ensure airway protection and treatment
of hypoxia.
 Self-suction with Yankauer suction tip.
 Pain and nausea: analgesics and
antiemetics may be indicated.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Ludwig's angina
 Oral bacterial cellulitis (inflammation);
floor of mouth under tongue.
 Occurs after infection of roots of teeth
(dental abscess) or mouth injury.
 Develops quickly; swelling can occlude
airway.
 Can be life threatening.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Ludwig's angina
 Breathing difficulty, confusion or mental
changes, fever, neck pain and swelling,
redness of the neck, weakness, fatigue,
excess tiredness, difficulty swallowing,
drooling, earache, speech that sounds
like person has "hot potato" in mouth.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Ludwig's angina
 In severe cases, surgical airway
(cricothyrotomy) may be required.
 Cured with proper protection of airways;
appropriate antibiotics.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Dentalgia and dental abscess
 Result of lack of preventive dental care,
restorative care, trauma.
 Non-life-threatening emergencies.
 Dental pain (dentalgia): exterior of tooth
broken down, allowing sensitive interior
structures (nerve) to be exposed.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Dentalgia and dental abscess
 In infection, development of closed-space
infections (abscesses) causes pain;
usually seen at gum line.
 Alleviation of pain, treat infection, dental
care.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Foreign body
 Lodged in mouth/throat; can obstruct
airway.
 At risk: children, psychiatric patients and
prisoners, patients who do not have
natural teeth.
 Ensure proper airway; transport to
facility where foreign body can be
removed.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Epiglottitis
 Inflammation or infection of epiglottis;
can be life-threatening emergency.
 Fever, sore throat, drooling, stridor,
hoarseness, difficulty breathing,
cyanosis.
 Protect airway; antibiotics.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Laryngitis
 Swelling and inflammation of larynx.
 Viral infection or drainage from upper
airway/sinus infection.
 Allergies, bacterial infections, injury,
chemical exposures, gastroesophageal
reflux disease (GERD), pneumonia.
 Fever, hoarseness, loss of voice.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Tracheitis
 Inflammation or infection of trachea.
 Bacterial infection; deep cough, dyspnea,
fever, stridor.
 Patient may be hypoxic.
 Prevent airway obstruction; ventilate
patient.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Throat
• Medical Conditions of Mouth and Throat
– Temporomandibular joint (TMJ)
 Problems with joint between temporal
bone and mandible (jaw).
 Malocclusion of teeth; orthodontic
appliances.
 Difficulty and pain in biting or chewing,
clicking or popping of TMJ joint, dull
facial pain, earache, jaw pain, headache.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• There will be instances during your
career as paramedic when you
encounter patients with nontraumatic
conditions involving the ears, eyes,
nose, mouth, throat, and associated
structures.
• Some may be life threatening.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Prehospital treatment priorities:
– Protection of airway, ventilation (if
required), circulation.
– Once established, try to identify cause
of problem and begin appropriate
treatment.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• In many instances, treatment is
symptomatic.
• Pain treated with appropriate analgesic;
nausea and vomiting treated with
appropriate antiemetic.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Other issues treated as directed by
local protocols.
• Many nontraumatic conditions involving
the ears, eyes, nose, mouth, and throat
can be true emergencies; prompt
recognition and treatment essential.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.