Emergency head and neck/NSS

Question 1

Criteria for CT head w/i 1 hour of head injury

Answer 1

GCS less than 13
GCS less than 15 2 hours after injury
Suspected open or depressed skull fracture
Sign of basal skull fracture
Post traumatic seizure
Focal neuro deficit
1+ vomiting

Question 2

What are some signs of basal skull fracture?

Answer 2

Haemotympanum
Panda eyes
CSF leak from ear or nose
Battles sign = bruising behind ear

Question 3

What is the criteria for performing a CT head wi 8 hours of head injury?

Answer 3

65+
Bleeding or coag disorder
Dangerous mechanism of injury
>30 mins retrograde amnesia

Question 4

Causes of epiglottitis

Answer 4

Bacterial - Strep, Staph, HiB
Non infectious - burns, presence of FB

Question 5

What are the CF of epiglottitis?

Answer 5

Fever
Drooling
Stridor
Pain
Sitting upright

Question 6

What is the management of epiglottitis?

Answer 6

Secure airway - inform anaesthetics and ENT
IV abx

Question 7

What are the different types of intracranial bleeds?

Answer 7

Subdural haemorrhage
Extradural haemorrhage
Subarachnoid haemorrhage
Intracerebral haemorrhage (haemorrhagic stroke)

Question 8

Location of subdural haemorrhage, cause and features

Answer 8

Location - between dura mater and arachnoid mater
Cause - ruptured bridging veins
Features - crescent shape on CT and not limited by cranial sutures

Question 9

Location, cause and features of extradural haemorrhage

Answer 9

Location - between skull and dura mater
Cause - middle meningeal artery in temporo parietal region (weakest part of skull), TRAUMA
Features - convex and limited by cranial sutures, +/- midline shift

Lucid interval

Question 10

Location and cause of SAH

Answer 10

Location - between pia mater and arachnoid membrane
Cause - ruptured cerebral aneurysm

Question 11

What is the management of extradural haemorrhage?

Answer 11

Craniotomy and evac of haematoma

Question 12

What is the stepwise approach of the management of epistaxis?

Answer 12

1. Direct compression
2. Cautery
3. Nasal packing
4. Nasal balloon cath or transnasal endoscopy w direct cautery or arterial ligation

Question 13

What are the signs and sx of glandular fever?

Answer 13

Fever
Sore throat
Fatigue
+/- hepatomegaly or splenomegaly

Question 14

What is the management of glandular fever?

Answer 14

• Rest
• OTC meds for fever and sore throat
• Avoid contact sports and heavy lifting for 1 month to reduce risk of splenic rupture