02 ER CONSULTS February 1 - 7, 2024.pptx

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1. February 1 – February 7, 2024 EMERGENCY ROOM CONSULTS EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY

2. MAXILLOFACIAL TRAUMA 5 PLASTICS 2 HEAD AND NECK 4 RHINOLOGY PHARYNGOLOGY 2 OTOLOGY 8 LBEN 6 PEDIATRIC ENT 20 TOTAL 47 ADMISSIONS 3 TOTAL ER Consults: February 1-7, 2024 ER Consults

3. EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference MAXILLOFACIAL TRAUMA

4. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/1 R.M. 33/M Multiple Facial Fractures involving the following: 1. Superior Orbital Rim, Complete, Non Displaced, Right 2. Lateral Orbital Wall, Complete, Displaced, Right 3. Anterior Table, Complete, Non Displaced 4. Le Fort I  5. Palatoalveolar , Open, Complete, Displaced 6. Dentoalveolar, Open, Incomplete, Displaced, Symphysis Septal Deviation Mladina Type III; Fracture, Closed, Complete, Transverse, Displaced, Medial 3rd, Shaft, Clavicle, Right Allman I; Fracture, Open, Complete, Articular, Comminuted, Tibial Plateau, Right Schatzker VI; Fracture, Closed, Complete, Transverse, Displaced, Proximal 3rd, Shaft, Fibula, Right secondary to MVA (DOI: 2/1/24) Nasal bone reduction Dental Impression Admitted (Ortho Main) SLA DLR/RMS/ STN Dr. Gutierrez

5. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/5 O.C. 40/F Abrasion, Left Upper Buccal Area secondary to Assault (DOI: 2/5/24) Chlorhexidine gargle TID Discharged PIN AMS/AVN Dr. David 2/5 T.D. 64/M Nasal Dorsum Abrasion secondary to Assault (DOI: 2/5/24) Nasal bone series – RR signed Mupirocin ointment BID Paracetamol 500mg/tab q6 PRN for pain Discharged PIN AMS/AVN Dr. David 2/6 D.F. 48/M Multiple Facial Fractures involving the following: 1. Frontal Bone, Comminuted, Left; 2. Supraorbital, Complete Non-Displaced, Left; 3. Mandible, Symphysis to Parasymphysis , Open, Complete, Displaced, Left Secondary to Assault (DOI: 1/28/2024) Plain Facial CT w/ 3D Reconstruction Dental impression Admit MRN DLR/MGN/STN Dr. Timbungco

6. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/6 E.M. 38/F Epistaxis, Anterior, Inactive secondary to Multiple Facial Fractures secondary to MVA (DOI: 1/24/24) Anterior nasal pack applied Tranexamic acid 500mg/tab TID x 3 doses Co-Amoxiclav 625mg/tab TID x 7 days Referred back to GS MRN DLR/MGN Dr. Timbungco

7. EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference PLASTICS

8. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/5 R.D. 44/M Laceration, Left Buccal Area secondary to Self-Accident (DOI: 2/5/24) Facial series – RR signed Wound suturing/LA Co-Amoxiclav 625mg/tab TID x 7 days Mupirocin ointment BID Chlorhexidine gargle TID Celecoxib 200mg/cap BID PRN Discharged PIN AMS/AVN Dr. David 2/6 A.C. 23/M Laceration, Posterior Auricular Area, Right secondary to Assault (DOI: 2/6/24) Wound suturing – RR signed Co-Amoxiclav 625mg/tab TID x 7 days Mupirocin ointment BID Paracetamol 500mg/tab q6 PRN Discharged MRN DLR/MGN Dr. Timbungco

9. EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference HEAD AND NECK

10. Date Name Age/ Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/2 L.C. 61/M Lateral Neck Mass, Squamous Cell Carcinoma, Moderately Differentiated by Biopsy Clinical Stage IVB (T3N0Mx) Betadine packing Tranexamic acid 500mg/tab q8 PRN for bleeding Celecoxib 200mg/tab BID PRN Discharged, Stable DMP HBC/MGN Dr. Almonte 2/3 A.V. 61/M Supraglottic Mass, Squamous Cell Carcinoma by Frozen Section, Clinical Stage IVA (T3N2cMx); Pulmonary tuberculosis completed treatment (2019); Hypertension Stage II; s/p Emergency Tracheostomy/LA (Dr. Avena / Felonia ) 11/26/23; Multinodular Toxic Goiter;  Type 2 DM, Newly Diagnosed;  HTN Stage II Controlled;  To consider Hepatic nodules; s/p Punch Biopsy of Intranasal Mass, Right with Ultrasound Guided Core Needle Biopsy of Supraglottic Mass with Frozen Section/LA (Dr. Mejico / Felonia ) 12/12/23 NGT insertion done Still for ChemoRT Advised follow-up at Tumor Clinic Discharged MDR PRG/DGL Dr. Alfanta

11. Date Name Age/ Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/4 M.S. 35/F Reactive Lymphadenitis rule out TB Adenitis Co-Amoxiclav 625mg/tab q8 x 7 days CXR PAL Sputum GeneXpert Discharged RJN ARZ Dr. Capuz 2/6 E.S. 51/M Tonsillar Mass, Left, to consider Malignancy Clinical Stage IVA (T4N0Mx) Prophylactic Tracheostomy/LA – RR signed Punch biopsy – RR signed NGT insertion – RR signed Chlorhexidine gargle TID Paracetamol + Tramadol tab q6 PRN Discharged MRN DLR/MGN/STN Dr. Timbungco

12. EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference RHINOLOGY

13. Date Name Age/ Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty None

14. EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference PHARYNGOLOGY

15. Date Name Age/ Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/2 T.B. 32/M Acute Tonsillopharyngitis, Non-Exudative Co-Amoxiclav 625mg/tab TID x 7 days Paracetamol 500mg/tab q6 PRN for pain q4 PRN for fever Chlorhexidine + Benzydamine gargle TID Discharged DMP HBC Dr. Almonte 2/7 J.T. 26/F Acute Tonsillopharyngitis, Non-Exudative Co-Amoxiclav 625mg/tab TID x 7 days Paracetamol 500mg/tab q6 PRN for pain q4 PRN for fever Chlorhexidine + Benzydamine gargle TID Discharged SLA MNZ Dr. Chiong

16. Prayer EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference OTOLOGY

17. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/1 A.P. 45/M Foreign Body (Cockroach) Right Ear Manual extraction Polymyxin B + Neomycin + Dexamethasone Otic Drops, 3 drops to Right TID for 7 days Paracetamol 500mg/tab q6 PRN Discharged SLA MNZ Dr. Gutierrez 2/2 J.A. 48/F Acute Otitis Media, Left Co-Amoxiclav 625mg/tab q8 x 7 days Paracetamol 500mg/tab q6 PRN Discharged MRN DLR Dr. Almonte 2/2 L.S. 29/F Chronic Suppurative Otitis Media, Bilateral Aural toilet Olfoxacin Otic drops 3 drops TID both ears x 14 days Discharged DMP HBC Dr. Almonte

18. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/3 T.D. 53/F Acute Otitis Media, Left; Impacted Cerumen, Right Co-Amoxiclav 625mg/tab q8 x 7 days Paracetamol 500mg/tab q6 PRN Baby oil 3 drops TID, right Discharged MDR PRG Dr. Alfanta 2/3 R.M. 42/M Impacted Cerumen, Bilateral Paracetamol 500mg/tab q6 PRN Baby oil 3 drops TID, right Discharged MDR PRG Dr. Alfanta 2/3 A.S. 38/F Acute Otitis Media, Right Co-Amoxiclav 625mg/tab q8 x 7 days Paracetamol 500mg/tab q6 PRN Discharged MDR PRG Dr. Alfanta

19. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/6 M.L. 33/M Acute Otitis Externa, Left Polymyxin B + Neomycin + Dexamethasone Otic Drops, 3 drops to Left TID for 7 days Paracetamol 500mg/tab q6 PRN Discharged MRN DLR Dr. Timbungco 2/6 J.F. 41/F Abrasion, Tragus, Post-auricular area, left secondary to Assault (DOI: 2/6/24); Impacted Cerumen, left Mupirocin ointment BID Baby oil 3 drops TID left x 5 days Referred back to GS MRN DLR/MGN Dr. Timbungco

20. Prayer EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference LBEN

21. Date Name Age/Sex Diagnosis Procedure / Management Disposition Resident Referred to Consultant on Duty 2/1 J.A. 37/M Flame burn 8% TBSA (DOI: 02/01/24) Video Laryngoscopy Suggest to start Dexamethasone 8mg IV as LD then 4mg IV q8 x 3 doses Suggest Omeprazole 40mg IV OD pre BF WOF: DOB, desaturations, voice changes Suggest standby intubation c/o main service if with DOB, desaturations, voice changes Referred back to GS SLA MNZ/RJS/STN Dr. Gutierrez

22. Date Name Age/Sex Diagnosis Procedure / Management Disposition Resident Referred to Consultant on Duty 2/2 D.S. 58/F Caustic Ingestion (Sodium Hypchlorite ) Non-accidental (DOI: 02/02/24) Video Laryngoscopy Suggest to start Dexamethasone 8mg IV as LD Suggest Omeprazole 40mg IV OD pre BF WOF: DOB, desaturations, voice changes Suggest standby intubation c/o main service if with DOB, desaturations, voice changes Suggest referral to Psychiatry and Toxicology Referred to EM MDR PRG/DGL Dr. Alfanta 2/4 V.G. 32/M Foreign body (Fish spine) Base of Tongue Manual extraction Co-Amoxiclav 625mg/tab q8 x 7 days Chlorhexidine + Benzydamine gargle TID Discharged RJN ARZ Dr. Capuz

23. Date Name Age/Sex Diagnosis Procedure / Management Disposition Resident Referred to Consultant on Duty 2/6 A.C. Flash Burn 15% TBSA (DOI: 2/6/24) Video Laryngoscopy Suggest to start Dexamethasone 8mg IV as LD then 4mg IV q8 x 3 doses Suggest Omeprazole 40mg IV OD pre BF WOF: DOB, desaturations, voice changes Suggest standby intubation c/o main service if with DOB, desaturations, voice changes Referred back to GS MRN DLR/MGN Dr. Timbungco 2/6 E.S. 66/F Vocal cord paralysis, Left, Etiology to be Determined Cranial CT with IVC Neck to Chest CT scan with IVC NGT insertion Referred back to IM MRN DLR/MGN Dr. Timbungco

24. Date Name Age/Sex Diagnosis Procedure / Management Disposition Resident Referred to Consultant on Duty 2/7 B.S. 30/F Caustic Ingestion (Sodium Hypochlorite) Non-Accidental (DOI 2/7/24) Video Laryngoscopy Suggest to start Dexamethasone 8mg IV as LD then 4mg IV q8 x 3 doses Suggest Omeprazole 40mg IV OD pre BF WOF: DOB, desaturations, voice changes Suggest standby intubation c/o main service if with DOB, desaturations, voice changes Referral to Toxicology and Psychiatry Referred back to EM SLA MNZ/RMS Dr. Chiong

25. Prayer EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference PEDIATRIC ENT

26. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/1 C.L. 2/M Foreign Body (Pellet), Right Ear Manual extraction Discharged SLA MNZ Dr. Gutierrez 2/1 T.A. 3/F Foreign Body (Seed), Right Nostril Manual extraction 0.65% NaCl nasal spray 2 sprays TID Discharged SLA MNZ Dr. Gutierrez 2/2 A.L. 5/M Acute Otitis Media, Right; Allergic Rhinitis, Mild Intermittent Co-Amoxiclav 457mg/5mL 4mL q8 x 7 days Paracetamol 250mg/5mL 4mL q6 PRN Fluticasone Proprionate nasal spray 2 sprays BID Discharged DMP HBC Dr. Almonte

27. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/2 J.D. 10/M Abrasion, Nasal Dorsum secondary to Alleged Assault (DOI: 02/02/24) Nasal bone series – RR signed Medicolegal certificate given Mupirocin ointment BID Paracetamol 250mg/5mL 5mL q6 PRN Discharged DMP HBC Dr. Almonte 2/2 A.A. 7/F Acute Otitis Externa, Left Polymyxin B + Neomycin + Dexamethasone Otic Drops, 3 drops to left TID for 7 days Paracetamol 250mg/5mL 4mL q6 PRN Discharged DMP HBC Dr. Almonte 2/3 R.H. 4/M Foreign Body (Plastic Pearl), Right Nostril Manual extraction 0.65% NaCl nasal spray 2 sprays TID Discharged MDR PRG Dr. Alfanta 2/3 Z.A. 3/M Foreign Body (Pellet),Right Nostril Manual extraction 0.65% NaCl nasal spray 2 sprays TID Discharged MDR PRG Dr. Alfanta

28. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/3 A.C. 8/M Foreign Body (Plastic Pellet), Right Ear Polymyxin B + Neomycin + Dexamethasone Otic Drops, 3 drops to left TID for 7 days Paracetamol 250mg/5mL 5mL q6 PRN Discharged MDR PRG Dr. Alfanta 2/3 M.D. 2/M Foreign Body (Button Battery), Right Nostril Manual extraction 0.65% NaCl nasal spray 2 sprays TID Referred to Pedia – Paracetamol 250mg/5mL 3mL q6 PRN Referred to Toxicology – Follow up after 3 days Discharged, Stable MDR PRG/DGL Dr. Alfanta 2/3 B.L. 5/M Foreign Body (3 Coins), Left Hemiabdomen CXR SFA done Referred to GS for discharge clearance Discharged, Stable MDR PRG/DGL Dr. Alfanta

29. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/4 F.B. 10/F Acute Otitis Externa, Left Polymyxin B + Neomycin + Dexamethasone Otic Drops, 3 drops to left TID for 7 days Paracetamol 250mg/5mL 7mL q6 PRN Discharged RJN ARZ Dr. Capuz 2/5 J.A. 15/F Soft Tissue Swelling, Left Temporal Area Secondary To Assault (DOI: 2/5/24) Skull Xray Facial series xray Paracetamol 500mg/tab q6 PRN for pain Discharged PIN AMS/AVN Dr. David 2/5 A.B. 13/M Acute Otitis Media, Bilateral Co-Amoxiclav 625mg/tab TID x 7 days Paracetamol 500mg/tab 1 tab QID PRN for pain Discharged PIN AMS/AVN Dr. David

30. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/5 S.M. 2/F Foreign Body (Seed), Left ear Aural flushing Discharged PIN AMS/AVN Dr. David 2/5 E.M. 5/M Foreign Body (Coin) Esophagus Level T3-T5 Emergency Esophagoscopy/GA Admit PIN AMS/AVN/RJS/FLN Dr. David 2/6 Z.T. 3/M Foreign Body (Bead) Right Nostril Manual extraction 0.65% NaCl Nasal Spray 2 sprays TID Discharged MRN DLR Dr. Timbungco

31. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty 2/6 Y.S. 12/M Foreign Body (Coin) Left Hemiabdomen CXR-PAL Scout film Abdomen Transfer of service to GS MRN DLR/MGN Dr. Timbungco 2/6 C.A. 6/M Acute Otitis Externa, Right Polymyxin B + Neomycin + Dexamethasone Otic Drops, 3 drops to right TID for 7 days Paracetamol 250mg/5mL 6.5mL q6 PRN Discharged MRN DLR Dr. Timbungco 2/7 A.B. 6/F Foreign Body (Magnet) Left Hemiabdomen CXR-PAL Scout film Abdomen Referral to Toxicology Transfer of service to GS SLA MNZ/RMS Dr. Chiong 2/7 R.C. 4/M Foreign Body (Button Battery), Right Nasal Cavity Emergency Foreign Body Extraction/ IV Sedation Admit SLA MNZ/RMS/ GTL Dr. Chiong

32. Prayer EAST AVENUE MEDICAL CENTER DEPARTMENT OF OTORHINOLARYNGOLOGY – HEAD AND NECK SURGERY Department Conference ADMISSION

33. Date Name Age/Sex Diagnosis Procedure/ Management Disposition Resident Referred to Consultant on Duty Subspec 2/5 E.M. 5/M Foreign body (Coin) Esophagus level T3-T5 Emergency Esophagoscopy/GA Admit PIN AMS/AVN/ RJS/FLN Dr. David PLBEN 2/6 D.F. 48/M Multiple Facial Fractures involving the following: 1. Frontal Bone, Comminuted, Left; 2. Supraorbital, Complete Non-Displaced, Left; 3. Mandible, Symphysis to Parasymphysis , Open, Complete, Displaced, Left Secondary to Assault (DOI: 1/28/2024) Plain Facial CT w/ 3D Reconstruction Dental impression Admit MRN DLR/MGN/STN Dr. Timbungco Maxillo 2/7 R.C. 4/M Foreign Body (Button Battery), Right Nasal Cavity Emergency Foreign Body Extraction/ IV Sedation Admit SLA MNZ/RMS/ GTL Dr. Chiong Rhino

34. THANK YOU!