Understanding patterns of injury in Kenya: Analysis of a trauma registry data from a NationalReferral Hospital
- If there is an insect in the external auditory canal, kill it first. They will fight for their lives if you try to dismember or take them out. “In the heat of battle, the patient can become terrorized by the noise and pain and the instrument that you are using is likely to damage the ear canal.”
- Vegetable matter in the ear? Don’t irrigate it – the organic material will swell against the fixed structure, and cause more pain, make it much harder to extract, and may increase the risk of infection.
- Beware of unilateral nasal discharge in a child – strongly consider retained foreign body
- Children 1 year and up, conscious – Heimlich maneuver: stand behind patient with arms positioned under the patient’s axilla and encircling the chest. The thumb side of one fist should be placed on the abdomen below the xiphoid process. The other hand should be placed over the fist, and 5 upward-inward thrusts should be performed. This maneuver should be repeated if the airway remains obstructed.
The differential diagnosis of vertigo can be broken into peripheral and central causes. It is imperative the Emergency Physician consider central causes of vertigo.
Signs/ Symptoms Differentiating Peripheral and Central Vertigo
|Onset||Sudden or Insidious||Sudden|
|Severity of Vertigo||Intense Spinning||Ill-defined, may be severe or less intense|
|Prodromal Dizziness||Occurs in up to 25%, often single episode||Occurs in up to 25%, recurrent episodes suggest TIA’s|
|Intolerant of head movements/Dix-Hallpike Maneuver||Yes||Varies, but often intolerant|
|Associated Nausea/Diaphoresis||Frequent||Variable, but often frequent|
|Auditory Symptoms||Points to peripheral causes||May be present|
|Proportionality of Symptoms||Usually proportional||Often disproportionate|
|Headache/Neck Pain||Unusual||More likely|
|CNS signs/symptoms||Absent||Usually present|
|Head Impulse Test||Abnormal||Often normal|
|HINTS Testing||Negative||Abnormal in at least 1 out of 3 tests|