2 - ENT emergencies

Question 1

what is septal haematoma?

Answer 1

= break of mucosal lining & bleed under mucosa

• it’s life threatening since chance of infection and this is in section where venous drainage is intercranial so risk of intercranial infection

Question 2

what timing is it suitable to fix nasal fracture?

Answer 2

either right at time on trauma or 1 week later (once bruising & swelling down)

• not after 3wks or longer as then need whole rhinoplasty etc

Question 3

what are some complications of nasal fractures?

Answer 3

epistaxis, CSF leak & meningitis (rare), anosmia (lack of smell from cribriform plate fracture)

Question 4

what is management of epistaxis?

Answer 4

= often sphenopalatine artery

• normal management like pinch bit of sift nose & tilt head forward (so blood out mouth & not into stomach)
• if in hospital then cautery (sticks that have silver nitrate on end, anaesthetise nose then paint blood vessel with chemical and deals with it)
• if in hospital & super sever then pack nose (fancy balloon with haemostatic material, put in nose and inflate (very uncomfortable so don’t do unless need to))

Question 5

what is role of tranexamic acid?

Answer 5

= given if lots bleeding - it’s a medication that makes more difficult for body to break down clot (keeps clot longer)

Question 6

what is CSF leak management?

Answer 6

= usually settle within 10 days alone (no antibiotics given)

• site of fracture might be cribriform plate

Question 7

what is pinna haematoma management?

Answer 7

• aspiration
• incision & drainage (within few days, not as urgent as septal haematoma)
• pressure dressing

= if left untreated then can result avascular necrosis of pinna due to lack of blood supply

Question 8

what is presentation of temporal bone fracture?

Answer 8

• battle sign (post auricular bruising after head trauma)
• hearing issues
• facial nerve palsy

*more head injury is main problem for these (not ENT stuff)

Question 9

is transverse or longitudinal temporal bone fracture worse?

Answer 9

transverse worse

transverse = more likely a frontal blow causing issues like facial palsy & hearing loss

longitudinal = more likely lateral blow making hearing problems

Question 10

what is sudden sensorineural hearing loss? and management?

Answer 10

less than 3 days = sudden hearing loss
- test with weber test
- give steroids which should resolve it (if not give intratympanic)

Question 11

what is main risky foreign body?

Answer 11

little batteries

Question 12

what is quinsy? presentation? manage?

Answer 12

= abscess related to tonsillitis (tonsillitis progressively worse until abscess developed)

PRESENTS:
- uvula deviated to 1 side
- change in voice
- muscle at back of throat gets irritated (struggle to open mouth - trismus)

MANAGE
- let pus out

Question 13

what is deep neck space infection? presents?

Answer 13

infection spread to rest of neck (extension of infection from tonsils & oropharynx)

PRESENTS
- sore throat, unwell, limited neck movement, febrile, trismus, red/tender neck

Question 14

what is supraglottitis? management?

Answer 14

= broad spectrum antibiotics

• risk of epiglottis heavy & swollen staying shut down like when swallow so can’t breathe

Question 15

what is pinna haematoma?

Answer 15

it’s typical after trauma injury in rugby & boxing - after initial truma the blood vessels in ear tear making haematoma between auricular cartilage & overlying connective tissue

Question 16

when is
a) nebulised
b) IV
c) intramuscular
adrenaline given?

Answer 16

a) airway issue
b) cardiac arrest
c) anaphylaxis