Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Section VI: Backcountry Medicine 203

Chapter 25 Review: HEENT

• In facial injury and infection, the most important initial diagnosis is: serious or not serious? • Significantly impaired eye function or associated pain indicates a serious problem. These issues include persistent visual changes, impaired EOM, impaired pupil dilation and constriction, severe lid swelling, hyphema, and headache. • The generic treatment for eye problems includes protective lenses, lubricating eye drops, irrigation as needed, and oral or topical antibiotics. Urgent evacuation is indicated for serious problems. • Nosebleed is usually easy to treat with direct pressure. A nosebleed that cannot be controlled carries the anticipated problem of volume shock. • Avulsed or fractured teeth are usually not a serious problem. Treatment includes replacing the tooth in the socket or cleaning and covering the fracture site. Infection is anticipated and antibiotics and non-urgent evacuation to dental care is warranted. • Dental infection is a serious problem. Field treatment includes pain relief, antibiotics, and urgent evacuation to dental care. • External otitis is usually a superficial skin infection of the ear canal and effectively treated with vinegar and alcohol or antibiotic ear drops. It becomes serious when it produces swelling and fever. • Middle ear and sinus infection is an obstruction-to-infection problem. It becomes serious when it produces persistent fever and severe pain and interferes with normal body function. The ideal treatment is drainage and antibiotics. • The use of antibiotics, where appropriate, in the treatment of injury and infection requires autho- rization and medical direction and is part of the overall risk reduction effort in the remote setting.

This peritonsillar abscess carries the serious antici- pated problems of airway obstruction, aspiration, and sepsis.