ENT emergencies Flashcards
what can significant nasal trauma be associated with?
- brain injury
- septal haematoma
how are septal haematomas treated?
drained in theatre
how can you tell if a lump in the nose is a septal haematoma?
-if its boggy and swollen
what can an untreated septal haematoma lead to?
-brain abscess
what is one of the most common emergencies seen in ENT?
epistaxis
what arteries are involved in epistaxis?
-internal and external carotid arteries
what is the management for epistaxis?
- pinch soft cartilage of nose for 5 minutes at a steady pressure
- may need to cautarise nose with nitrate
- if this doesn’t work may need to pack the nose for 24 hours
If bleeding controlled:
- arrange admission if packed/poor social circumstances
- FBC
- G&S
If bleeding not controlled:
- arrange admission
- FBC
- G&S
- consider arterial ligation (sphenopalatine artery, anterior ethmoid, external carotid)
what is the management for a patient who is really ill/ hypovolaemic with epistaxis?
- resus
- arrest/slow flow: pressure, ice, topical vasoconstrictor +/- LA (Lignocaine + adrenaline, Co-phenylcaine)
- remove the clot using suction and nose blowing
- cauterise using silver nitrate/diathermy and pack if you can
- Tranexamic acid
- take off anticoagulants/change
- platelet transfusion
- treatment for hypertension
- correct clotting abnormalities
If bleeding controlled:
- arrange admission if packed/poor social circumstances
- FBC
- G&S
If bleeding not controlled:
- arrange admission
- FBC
- G&S
- consider arterial ligation (sphenopalatine artery, anterior ethmoid, external carotid)
what are rapid rhino packs used for?
- for ‘packing’ in epistaxis
- this can be very painful so may need analgesia on nose
what often causes a CSF leak?
-nasal trauma leading to a fracture in the cribriform plate
how long does it tend to take a CSF leak to resolve?
10 days
what is pinna haematoma?
cauliflower ear
what is the treatment for pinna haematoma?
either aspirate or incise and drain
if recurrent or big incise and drain (however this leaves a larger scar)
what is the management of lacerations?
- Debridement
- Closure (primarily if can)
- Antibiotics especially if cartilage showing to avoid infection