Non-traumatic Conditions of the Throat
404 ENT emergencies
(e) remember in adults the nose extends 6.5–7.5 cm backwards
to the posterior choanae.
(iii) Give the patient amoxycillin 500 mg orally t.d.s. and refer to the
ENT team for admission with removal of the pack within 48 h.
3 Severe posterior bleeding
(i) Anterior and posterior nasal tamponade
Stem posterior nasal bleeding by inserting a double epistaxis-balloon
device, with separate balloons for anterior plus posterior tamponade.
Tape securely to the cheek.
(ii) Use a Foley urethral catheter if tamponade is unavailable, and
insert far back along the floor of the nose, inflate the retaining
balloon with air, and pull the catheter forwards to occlude the
back of the nose. Tape the catheter securely to the cheek to
prevent it slipping backwards
(a) then insert an anterior nasal pack as described previously
(b) occasionally both sides of the nose require packing to stop
the bleeding.
(iii) Refer the patient immediately to the ENT team for admission.Traumatic Conditions of the Throat
See Section VIII, Surgical Emergencies: Neck Injuries, p. 224.NON-TRAUMATIC CONDITIONS OF THE THROAT
Tonsillitis
DIAGNOSIS AND MANAGEMENT
1 This is more frequently viral than bacterial, but differentiating the two clini-
cally is difficult.
(i) Fever above 38°C (100°F), tender cervical adenopathy, tonsillar
exudate and absence of cough favour -haemolytic Streptococcus,
particularly in children aged 3–14 years.
(ii) Glandular fever (EBV) presents with a grey, exudative tonsillitis
typically in late adolescence.
2 There is fever, fetor, sore t hroat and dysphagia.
(i) A febrile convulsion may be precipitated in a child <5 years
old.