EN2.10 | ENT Emergency Simulation Workflow — Summary & Reflection

KEY TAKEAWAYS

ENT emergency triage: ABCDE first; airway compromise is the highest priority. Immediately life-threatening: laryngeal FB (stridor + cyanosis → Heimlich/back blows/chest thrusts → cricothyroidotomy if airway not cleared), failed intubation (cricothyroidotomy through cricothyroid membrane — emergency only; tracheostomy 2nd–3rd rings = elective planned airway), button battery in nose/ear (remove immediately — necrosis within 1–2 hours). Epistaxis: sit forward + lean forward (never back); pinch soft nose 15 min; topical vasoconstrictor; anterior packing — Merocel or ribbon gauze along the nasal FLOOR posteriorly. If blood in pharynx despite anterior packing = posterior bleed: Foley catheter balloon to posterior choana. Foreign bodies: ear — wax hook (never forceps for smooth FBs); syringing contraindicated if TM perforation or vegetable FB; nasal FB — never push posteriorly, anterior extraction or positive-pressure technique; laryngeal FB — Heimlich (adults/children >1 yr), back blows + chest thrusts (infants); oesophageal FB — rigid oesophagoscopy under GA. Three oesophageal narrowings: cricopharyngeus (C6), aortic arch/left main bronchus, LOS.

REFLECT

In your clinical posting, observe the first epistaxis patient managed in the casualty department. Watch the technique: does the clinician position the patient leaning forward? Is the packing inserted along the nasal floor or upward? Is the posterior pharynx checked after packing? After the procedure, ask yourself whether you could have performed each step correctly if you had been alone with the patient. If the answer is no for any step, identify the specific step and practise it in the simulation lab. ENT emergencies do not give you the opportunity to stop and re-read the protocol — the competency must be internalised before the emergency arrives.