Emergency Flashcards
Describe the movement of the epiglottis and vocal cords
They open up when we breathe and close when we swallow
Vocal cords are close together during phonation
List the special features of the airway in children and babies
They breathe through their nose Have a relatively large tongue and large head Small and soft larynx that sits higher Weak neck muscles Floppy head
What is the equation for air flow resistance
Its proportional to 1 over the radius to power 4
Exponential increase in resistance as the radius gets smaller
List common causes of airway obstruction
Inflammation Infection Allergy Foreign bodies Physical compression Trauma Burns Neurological causes Neoplastic causes Congenital problems
List symptoms of airway obstruction
SOB Coughing Choking Sternal or subcostal recession Dysphagia Dysphonia Cyanosis Stridor
List signs of acute epiglottitis
Red, swollen epiglottis
Breathlessness
Drooling
What causes recurrent respiratory papillomatosis
HPV infection
There is no cure
What can respiratory distress progress on to
Respiratory failure
Respiratory arrest
Cardiac arrest
How do you manage an airway obstruction
A,B,C: Resuscitation Oxygen Heliox - helium mixed with oxygen Steroid Adrenaline Endoscopy Tracheostomy (if needed) Treat underlying problem
List signs of nasal trauma
Bruising and swelling Tenderness Deviation Epistaxis Cranial nerve dysfunction
What is a septal haematoma
Bulging mass in nostril – seen on otoscope
Blood under the perichondrium – loss of blood supply to cartilage
Occurs after trauma
Treat by draining and sewing back into place
List complications of nasal trauma
Epistaxis
CSF leak
Meningitis
Anosmia
How do you treat nasal fracture
Treatment is based in deviation, breathing and cosmesis
Leave for 5-7 days to let swelling settle
If needed use digital manipulation
What is epistaxis
Nose bleed
Which blood vessles are found in the nose and may lead to epistaxis
Sphenopalatine artery
Etmoid arteries
Greater palatine artery
How do you manage a nose bleed
Apply external pressure to the nose and lean forward Ice Cautery Nasal packing Topical vasoconstrictors Remove any clots
At what point does a nose bleed need medical attention
If it doesn’t stop in 20 mins
What can cause a CSF leak
Fracture to part of the skull - usually ethmoid as so thin
It often resolves itself
Needs surgery if not
What is a pinna haematoma
Caused by trauma to the outer ear - common in rugby
Bleed occurs under the perichondrium
If not treated the cartilage loses blood supply and becomes deformed - cauliflower ears
How do you treat a pinna haematoma
Aspirate
Incision and drainage
Pressure dressing
Avoid contact
How do you treat an ear laceration
Debridement
Closure - done under LA
Need antibiotics if cartilage is exposed
What are the classifications of temporal bone fractures
Longitudinal or transverse
Describe the presentation of longitudinal temporal bone fractures
Caused by lateral blows to head Bleeding from external ear canal Haemotympanum and ossicular chain disruption cause conductive deafness Facial palsy CSF leak from nose
Describe the presentation of transverse temporal bone fractures
Caused by frontal blows Can damage facial and auditory nerves SN hearing loss more likely than long to cause hearing loss Facial nerve palsy Vertigo
What one foreign body must be removed from the ear immediately
Small batteries - chemical s can burn the ear
How do you treat a bug in the ear
Drown it in oil and remove when able
In terms of neck trauma, what is included in zone 1
Low down on neck: Trachea Oesophagus Thoracic duct Thyroid Vessels Spinal cord
Very dangerous area to injure
In terms of neck trauma, what is included in zone 2
Middle of neck Larynx CN 10,11,12 Vessels – carotids, internal jugular Spinal Cord
In terms of neck trauma, what is included in zone 3
Upper neck - between jaw and skull base Pharynx Cranial Nerves Vessels – Carotids, IJV, Vertebral Spinal Cord
What are the signs of a deep neck space infection
Sore throat Limited neck movement Systemically unwell Febrile Red and tender neck
How do you treat a deep space neck infection
Fluid resuscitation
Intravenous antibiotics
Incision and drainage of neck space
What are the signs of an orbital fracture
Pain Red eye Decreased visual acuity or double vision Oedema Restricted eye movement Numb around eye Bruising
What is seen on a CT of an orbital fracture
Tear drop sign
Caused by contents of orbits pushing through break
Describe the Le Fort fracture classifications
1 - breaks horizontally above the upper teeth (through maxilla)
2 - Pyramidal shape to fracture, through maxilla, lacrimal bone, zygoma etc. over nose and under eyes
3 - transverse, whole lower face detached (lower orbit and nose etc)
