ENT Foreign Bodies Case Study

As we discussed during the meeting last month, I do not enter comments regarding the health reasons for the referral because I do not have the expertise of the nurses understanding how a particular referral or diagnosis fit the different classifications. For example, does a referral to ear, nose, and throat indicate a congenital condition, other health conditions, or allergies?

A 49-year-old, Middle Eastern male presented to the Northern Virginia Community College dental hygiene clinic for both an oral prophylaxis. He was in good health and did not use any medications or supplements and, therefore, was classified as a health status of ASA I. The patient’s vital signs included a blood pressure of 112/78 RAS, pulse of 64 beats per minute, and a respiratory rate of 14 respirations per minute, which further concluded his health status. Patient had no history of any tobacco use, nor did he consume any alcohol.

Ans- Most complications of pediatric foreign body ingestion are due to site of esophageal impaction, usually at 1 of 3 typical locations. The most common site of esophageal impaction is at the thoracic inlet. Defined as the area between the clavicles on chest radiograph, this is the site of anatomical change from the skeletal muscle to the smooth muscle of the esophagus. The cricopharyngeus sling at C6 is also at this level and may "catch" a foreign body.

Identification of the difficult airway before manipulation is the Holy Grail of clinical management. It is the first step in preparing for patient care. Selection of airway devices, techniques, and procedures all pivot on airway evaluation (Carin, 2008).

The patient was a female, 95 years of age. In the beginning of July 2013, she frequently choked during a meal and we examined her with deglutition endoscope.

His main concern was his Tinea Pedis and Onychomycosis that has not been resolved and has required changes on treatment (refer to section 7). Ricardo had an episode of RT olecranon bursitis that was treated with steroids and analgesic gel, problems resolved w/o complications. Flu vaccine administered on 9/21/16. Hearing evaluation exam indicating mild hearing loss. No changes in mobility or daily activities; he remains on 1:1 level of supervision to prevent injuries.

The patient is a 59-year-old patient of Karen L. Palmer, DO. She tells me that she is prone to sinus infections. She has not however been treated for one in quite some time. She tells me that she does have some rhinorrhea that occurs in the morning for the past decade or so. She does not use any nasal sprays. She tells me that she was doing quite well until yesterday afternoon when she started having pain in the right side of her face and her upper teeth. She denies any fatigue, no fevers, no postnasal drip, no increase in her rhinitis. She denies any cough. She is a smoker of cigarettes and does desperately want to quit. She did discuss this ready with her primary care physician. The patient denies

I suggest you revisit your primary care doctor for a referral to an Ear/Nose/throat specialist and suggest the above to them for consideration and evaluation.

He was given the appropriate treatment. Over the following 2 years, his health steadily improved: his weight and height are now on the 10th centile, and he has had only one episode of otitis media in the last 18 months

Since she is a medi-cal recipient her choice of available ENT’s was narrowed to a handful.

PMH: Charles has history of Intermittent asthma since he was 2 years old, uses Ventolin inhalers as PRN. Mother reports that prior to current illness Charles was having asthma symptoms requiring inhaler use 1-2 times/week, typically during the day, lasting 1-2 hours, without effect on Charles’ activity. Attacks have occurred both at home and outdoors. Charles is a full term baby, product of NSVD, with no antenatal complications. Birth weight was 3000g, with apgar score of 9 in both 1 and 5 minutes. History of adenoid hypertrophy diagnosed at the age of 2 years. Patient is followed up by ENT. History of recurrent URTI, the last visit to ER was last month due to fever, coughing, and runny nose, treated as viral infection. History of otitis media 3 months ago that was treated with Azithromax. Up to date with vaccinations, the last Flu shot given on April 2,

The antihistamine medication did not cure or diminish the Eustachian tube dysfunction. An examination by an otolaryngologist (ENT) will be necessary to detect ear disease or injury that is present. Medicaid benefits affiliated with a health maintenance organization will be in effect in two weeks, and I will be able to have a private practice physician examine my ears for infections and injuries. I was given a recommendation to be examined by a physician with excellent reviews.

His 2 week dental S/P consult revealed fair oral hygiene, good tissues, negative oral cancer screen, type II-III periodontal disease, no dental caries.

Tongue The patient has pink tongue with out any sores Oropharynx the patient oropharynx is clear pink no any discharge or abnormal spots

The head, ear, eyes, nose, and throat (HEENT) are common sources of complaints seen amongst pediatric patients, particularly during the winter season, and the flu season. The common infections involving the HEENT are pharyngitis, strep throat, rhinitis, sinusitis, otitis media and externa, and conjunctivitis. The American Academy of Pediatrics (2013), has suggested the route of treatment that practitioners should elect when treating these conditions. It is suggested that no antibiotics be prescribed unless the provider is certain that the person has an infection; they recommend that no antibiotics be given to patients with clear discharge and who are afebrile (AAP, 2013). In an effort to decrease antibiotic resistance and as per the AAP (2013) recommendations, I