Otolaryngologic clinics of North America
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Otolaryngol. Clin. North Am. · May 1979
The initial evaluation of the patient with multiple injuries.
The management of trauma patients requires organization and the cooperation of trained health personnel, beginning at the site of injury and continuing until the patient is discharged from the hospital. Treatment guidelines and priorities must be well outlined in advance to provide optimal care and minimize delay prior to definitive therapy. Resuscitation and treatment must begin immediately and simultaneously following well established principles. These guidelines and the general care of the patient with multiple trauma are discussed in this article.
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The recognition and proper initial handling of the many types of ocular injury will result in increased preservation of eyesight and fewer complications. This presentation has attempted to provide some of the general principles of ocular examination as a guide to the physician in dealing with ocular trauma.
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The differential diagnosis between the usual acute otitis externa and acute suppurative otitis media is presented. Other important and sometimes frequently seen entities that present as infections in the ear are also discussed. It is emphasized that a patient complaining of ear pain with normal findings on examination must be more thoroughly investigated because of the possibility of a more ominous condition such as carcinoma of the pharynx.
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The tongue is the most common cause of upper airway obstruction, a situation seen most often in patients who are comatose or who have suffered cardiopulmonary arrest. Other common causes of upper airway obstruction include edema of the oropharynx and larynx, trauma, foreign body, and infection. The management of the patient with upper airway obstruction depends upon the cause of the obstruction, the training and skills of the rescuer, and the availability of adjuncts necessary to perform advanced airway techniques. ⋯ The choice of technique depends primarily on the experience and skills of the rescuing physician or paramedic. In most cases, cricothyroidotomy is technically more simple and more easily performed than tracheotomy, especially for the physician who has not been trained in surgery or otolaryngology and for the nonphysician rescuer. No matter what the method employed in establishing an airway in a patient with upper airway obstruction, it must be performed quickly and a source of ventilation provided for the patient once the airway has been secured.