Otolaryngologic clinics of North America
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1. Do not create an emergency obstruction unless you are prepared to handle it. (It may be best to do nothing until the diagnosis is clear.) 2. Support the patient with oxygen, humidity, and positioning and monitor vital signs. 3. Take as brief, concise, and accurate a history as possible. 4. Determine the anatomic level of obstruction. 5. Estimate the degree of obstruction with the maximal potential hazard. 6. Carry out a physical examination of the nose and neck and, except in suspected epiglottitis, the pharynx, larynx, trachea, and lung. 7. Special x-ray studies--lateral, neck and chest, swallowing function, and inspiratory and expiratory films--are obtained as indicated. 8. Therapeutic support: oxygen, humidity, antibiotics, steroids, and recemic epinephrine. Mechanical support: naso-oral airways, appropriate endotracheal or bronchoscopic tubes. ⋯ tracheotomy.
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The management of trauma to the air and food passages has been reviewed briefly, with emphasis on the management of the acute problems based upon a thorough evaluation.
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Because of the large numbers of head injuries, physicians are frequently called upon to evaluate and initiate treatment in these acute emergencies. Deterioration of such patients results from direct injury to the brain tissue and a subsequent increase in the intracranial pressure. The pathophysiology of brain injury is manifested in a cycle of detrimental events with increased tissue damage and progressive neurological deficit. Current concepts in management of head injuries aimed at interrupting this cycle of events are discussed in detail.