Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks

Emergency management of ENT conditions requires a systematic approach to distinguish common, benign presentations from life-threatening emergencies. Epistaxis is primarily managed through visualization, anesthesia, and mechanical tamponade, as hypertension is rarely a direct cause. Nasal foreign bodies are best addressed using positive pressure techniques like the "parent's kiss" to avoid traumatic instrumentation. Malignant otitis externa demands high clinical suspicion in diabetic or immunocompromised patients presenting with otalgia and granulation tissue, where gallium scanning serves as a sensitive diagnostic tool. Epiglottitis in adults, while potentially airway-threatening, often allows for close observation rather than immediate intubation, provided the airway is monitored. Finally, angioedema requires differentiating between histamine-mediated allergic reactions and bradykinin-mediated forms, such as hereditary or ACE inhibitor-induced cases, which necessitate specific interventions like C1 esterase inhibitors rather than standard antihistamine cocktails.