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10 Assessment and care of ENT problems
  1. S Carter,
  2. C Laird
  1. BASICS Scotland, Auchterarder, UK
  1. Correspondence to:
 Dr S Carter
 BASICS Scotland, Auchterarder, UK;

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The vast majority of ENT (ear, nose, and throat) problems that present in the prehospital setting are minor in nature. However, occasionally innocuous symptoms can develop into life threatening conditions that require immediate assessment and treatment.

Article objectives

  • To undertake a primary survey of the patient and treat any immediately life threatening problems.

  • To identify any patients who have a normal primary survey but have an obvious need for hospital admission.

  • To undertake a secondary survey (full assessment) including history and examination targeted to the presenting symptom.

  • To consider a list of differential diagnoses.

  • Discuss treatment based on the probable diagnosis (es) and whether home management or hospital admission is appropriate.

  • Consider need for follow up.


The primary survey is a rapid assessment tool that uses the ABC principles to look for an immediately life threatening condition.

Box 1 Primary survey

If any observations below are present treat immediately and transfer to hospital

  • Airway obstruction

  • Respiratory rate <10 or >29

  • Oxygen sats <93%

  • Pulse <50 or >120

  • Systolic blood pressure <90

  • Glasgow coma score <12

ENT conditions can be immediately life threatening by causing an A, B, or C problem:

  • A Airway obstruction/compromise—inhaled foreign body, epiglottitis, quinsy, anaphylaxis/angio-oedema, croup, facial fractures.

  • B Breathing difficulty—croup, inhaled foreign body

  • C Circulatory compromise—haemorrhage, for example, epistaxis, from facial fracture, secondary haemorrhage after ENT surgery, for example, after tonsillectomy.


Patients with all of the above conditions can show a range of severity of symptoms and signs, which can deteriorate. It is essential to remember that in the early stages of these conditions, patients may not have significant abnormal physical signs. The recognition of developing airway obstruction is critical and management of the condition may require the use of airway adjuncts to maintain adequate oxygenation. If there is complete airway obstruction and airway adjuncts have …

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  • Funding: none.

  • Conflicts of interest: none declared.