CCP 221 ENT Emergencies 👂👃 Flashcards
cranial nerves associated with extra ocular movement
III, IV, VI (3,4,6)
“S.H.O.R.T” acronym for predictors of difficult cricothyrotomy
S - Surgery (recent/prev neck surgery) H - Hematoma (zone 2 hematoma) O - Obese (lots of fatty tissue) R - Radiation distortion (thick, fibrous tissue) T - Tumor (zone 2 space occupying mass)
peripheral vertigo (define, describe, differentiate from central vertigo)
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describes vertigo caused by lesions affecting the inner ear and cranial nerve VIII (vestibulocochlear nerve)
sudden onset, intermittent/fluctuating, more severe symptoms
affected by head position/movement
motor function/gait typically intact
CAUSES:
benign paroxysmal positional vertigo (BPPV) vestibular neuritis Meniere's disease acoustic neuroma aminoglycoside toxicity semicircular canal dehiscence syndrome perilymphatic fistula herpes zoster oticus (Ramsay Hunt syndrome)
central vertigo (define, describe, differentiate from peripheral vertigo)
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vertigo caused by lesions affecting the brainstem and cerebellum
gradual onset, constant, more mild symptoms
unaffected by head position/movement
motor function/gait unstable
CAUSES:
vestibular migraine brainstem stroke multiple sclerosis ischemic or hemorrhagic damage to the cerebellum cerebral edema high altitude cerebral edema
The four cranial nerves involved in vision and movement of the eyes
CN II optic nerve (sensory)
CN III oculomotor (motor)
CN IV trochlear (motor)
CN VI abducen (motor)
What 3 cranial nerves directly control the eye muscles?
CN III oculomotor (motor)
CN IV trochlear (motor)
CN VI abducen (motor)
cranial nerves controlling the position of the eyeballs
CN III oculomotor (motor)
CN IV trochlear (motor)
CN VI abducen (motor)
what cranial nerve influences the position of the eyelids and the size of the pupils
oculomotor (III)
3 zones of the neck
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Zone 3 - Angle of mandible to base of skull (UPPER ZONE)
Zone 2 - Cricoid to angle of mandible (MIDDLE ZONE)
Zone 1 - Clavicle to cricoid cartilage (LOWER ZONE)
5 eye vital signs
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1) Visual acuity (Snellen chart)
2) IOP (Tonometer)
3) Pupils (pupil exam)
4) Extraoccular movement (H-test)
5) Visual Fields (visual field exam)
hyphema (describe + define)
Blood pooling in the anterior chamber of the eye
iridocyclitis (describe + define)
Inflammation of the iris
iridodialysis (describe + define)
Tearing the iris root from the ciliary body causing a double pupil
what ophthalmic condition is characterized by a patient complaint of seeing “flashes and floaters”
Vitreous hemorrhage
what cranial nerve has been impacted to elicit a “down and out” pupil presentation?
CN III (oculomotor)
what cranial nerve has been impacted to elicit a “medially deviated” pupil presentation?
CN IV (abducens)
Ludwig’s angina (describe + define)
Bilateral infection of the submandibular space in the deep neck that begins as a cellulitis in the floor of the mouth
LeFort fracture definition
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fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base
Le Fort type I
Le Fort type I - horizontal maxillary fracture, separating the teeth from the upper face
Le Fort I is a floating palate (horizontal)
Le Fort type 2
Le Fort type II - pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex
Le Fort II is a floating maxilla (pyramidal)
Le Fort type 3
Le Fort type III - craniofacial disjunction
Le Fort III is a floating face (transverse)
pathophysiology of trismus in deep space neck infections
local inflammation of the muscles of mastication or the direct involvement of these muscles by the infection
“Hard Signs” of neck trauma
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🥼🥼🥼PIMP-ABLE TOPIC🥼🥼🥼
- Airway compromise
- Air bubbling wound
- Expanding or pulsatile hematoma
- Active Bleeding
- Shock, compromised radial pulse
- Hematemesis
- Neuro Deficit/Paralysis/Cerebral ischemia
- Absent or unequal radial pulse
“Soft Signs” of neck trauma
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🥼🥼🥼PIMP-ABLE TOPIC🥼🥼🥼
- Subcutaneous emphysema
- Dysphagia, dyspnea
- Non-pulsatile, non-expanding hematoma
- Venous oozing
- Chest tube air leak
- Minor hematemesis
- Paresthesias
Zone III (upper neck) structures
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Distal portion of the internal carotid arteries Vertebral arteries Jugular veins Pharynx Spinal cord Cranial nerves IX, X, XI, XII Sympathetic chain Salivary and parotid glands
Zone II (midneck) structures
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Common carotid arteries Internal and external branches of carotid arteries Vertebral arteries Jugular veins Trachea Esophagus Larynx Pharynx Spinal cord Vagus and recurrent laryngeal nerves
Zone I (low neck) structures
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Thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins) Proximal carotid arteries Vertebral artery Apices of the lungs Trachea Esophagus Spinal cord Thoracic duct Thyroid gland Jugular veins Cranial nerve X (vagus nerve)
differentiating central vs peripheral vertigo
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PERIPHERAL: think SUDDEN ONSET, SEVERE, inner ear and cranial nerve VIII (vestibulocochlear nerve) involvement
CENTRAL: think CHRONIC, GRADUAL ONSET, MORE MILD, brainstem involvement
signs of impending airway failure in epiglottitis
- Drooling
- Muffled voice
- Stridor
- Hypoxia
- Sniffing position (sitting upright with neck extended)
characteristic XR finding in epiglottitis
- Thumbprint sign of epiglottitis lateral neck XR
2. Presence of a “thumb-like” epiglottis on lateral soft tissue neck radiograph is concerning for epiglottitis
pathophysiology of epiglottitis
- Inflammation of the epiglottis can lead to airway obstruction
- Epiglottitis was previously seen primarily in children as a result of Haemophilus influenzae type b infection
- Since the widespread adoption of vaccination against Haemophilus influenzae type B, the incidence of epiglottitis infections has decreased, and the mean age of patients with epiglottitis is now 45 years
- In the era following Haemophilus influenzae type B vaccination, Streptococcus and Staphylococcus are now the leading causes of epiglottitis
Physical exam findings concerning for oropharyngeal infection
- Trismus (local inflammation of the muscles of mastication)
- Nuchal rigidity
- Uvular edema or deviation
- Submental edema or tongue elevation
pathophysiology of Peritonsillar abscesses (quincy)
- Tonsillar inflammation and cellulitis can progress to PTA.
- PTA can also result from obstruction of Weber glands (salivary glands in the soft palate).
- Complications include abscess rupture and aspiration, erosion into the carotid sheath leading to hemorrhage, extension into the deep tissues of the neck and mediastinum, and airway obstruction
pathophysiology of ludwig’s angina
Infection and edema of the submandibular space (sublingual and submaxillary spaces) can rapidly lead to airway obstruction.
classically results from the spread of odontogenic infection and is frequently polymicrobial.
