General Otolaryngology and Emergency Care
Core rules
Airway foreign bodies require Heimlich maneuvers or rigid bronchoscopy; esophageal coins need removal, but a button battery is an emergency because of rapid mucosal necrosis. Deep neck space infections such as Ludwig's angina cause floor-of-mouth swelling, trismus, drooling and airway compromise. Management is airway control, intravenous antibiotics and surgical drainage. Peritonsillar abscess presents with unilateral sore throat, trismus and uvular deviation; treatment is needle aspiration or incision and drainage, with antibiotics. Immediate tonsillectomy is not routinely required. Epiglottitis and severe croup can obstruct the airway; avoid forceful throat examination in suspected epiglottitis. Cricothyrotomy is a rescue airway when intubation fails. Epistaxis first aid is pinching the nose and leaning forward; posterior bleeding may need packing or arterial control.
Worked example
A 45-year-old has fever, drooling, trismus and bilateral floor-of-mouth swelling. This is Ludwig's angina. The airway is secured early, broad-spectrum intravenous antibiotics are started, and the submandibular spaces are drained. Dental sources are addressed.
Traps
Do not examine the throat forcefully in suspected epiglottitis. Do not delay removal of a button battery. Not every peritonsillar abscess needs immediate tonsillectomy. Do not send a patient with Ludwig's angina home on oral antibiotics.