Potential for In-Office ENT Emergencies on the Rise

Thankfully, emergencies are rare in the otolaryngology office setting. But, as more and more procedures move from the operating room to the office—including balloon sinuplasty, endoscopic procedures and skin cancer reconstruction—the potential for in-office emergencies increases. Are you adequately prepared?

“It’s absolutely essential to have a plan, equipment and emergency procedures in place so that you’re well-prepared when something happens, because it will happen at some point,” said Brad DeSilva, MD, residency program director in the department of otolaryngology, head and neck surgery at Ohio State University in Columbus.

All otolaryngologists in private practice should be equipped for and prepared to handle airway emergencies and excessive bleeding, the two most common otolaryngology-related emergency scenarios. Additional emergency preparation will depend on your area of practice. An otolaryngology office that offers allergy shots, for instance, must be prepared to handle anaphylactic shock.

Pre-planning and practicing your response are essential. “These are life-saving, high-stakes, time-sensitive and clinically important skills,” said Kevin Fung, MD, an otolaryngologist at London Health Sciences Center in Ontario and one of the organizers of “Emergencies in Otolaryngology–Head and Neck Surgery Bootcamp.” The bootcamp, held last fall, included faculty and junior residents from 10 U.S. and Canadian universities and hospitals. “The simulation-based bootcamp trained first- and second-year residents specializing in otolaryngology emergency life-saving skills before they experienced life-threatening situations during their residency,” said Dr. Fung.

Emergency Prevention

The first step of emergency preparation is figuring out how to avert a crisis. Careful selection of patients can help you avoid unnecessary in-office emergencies.

“You don’t want to see patients in your office that you can’t handle if anything goes wrong,” said Hootan Zandifar, MD, an otolaryngologist who specializes in facial plastics and reconstructive surgery at the Osborne Head and Neck Institute in Los Angeles. “Pre-selecting your patients prevents a lot of issues.”

Consider your patients’ overall health. Be aware of issues such as high blood pressure or use of anticoagulants. “If your patient is on a blood thinner, he may become more than you can handle in the office,” Dr. Zandifar said. “You don’t want to do a procedure on a patient like that in the office, where you have limited help available.”