HEENT

The first useful question is not “What does the ear or throat look like?” It is whether the patient can see, hear, breathe, swallow and protect the airway adequately. A focused HEENT assessment becomes urgent when a local complaint may represent airway obstruction, orbital or neurologic disease, major bleeding, or rapidly progressive infection. Assess appearance, work of breathing, voice, ability to handle secretions, mental status and vital signs before a detailed examination. Stridor, drooling, a muffled voice, inability to swallow saliva, rapidly enlarging tongue or neck swelling, or increasing respiratory effort takes priority over throat inspection. Keep the patient upright, call for immediate assistance and prepare for an airway response according to local policy. Sudden vision loss, severe eye pain with reduced vision, new proptosis, painful restriction of eye movement, or a new visual-field deficit requires urgent escalation. Do not allow a lengthy history or routine visual screening to delay help when vision or neurologic function is deteriorating. For epistaxis, first determine whether the patient is stable and whether blood is entering the oropharynx. Hypotension, tachycardia with poor perfusion, syncope,...