ENT emergencies Flashcards
what do you examine for in nasal trauma
- bruising/swelling
- tenderness
- deviation
- epistaxis
- infraorbital sensation
- CNs
management for epistaxis if bleeding is not controlled
consider arterial ligation
systemic treatment of epistaxis
- tranexamic acid
- reversal of effect of anticoagulants
- correction of clotting abnormalities
- platelet transfusion
- treatment of hypertension
what does a CSF leak mean
that the site of fracture may be the cribriform plate
name some ear emergencies
- pinna haematoma
- ear lacerations
- temporal bone fractures
- sudden sensorineural hearing loss
treatment for a pinna haematoma
- sub-perichondrial haematoma
- aspriate
- incision and drainage
- pressure dressing
management for ear lacerations
- debridement
- closure
- reconstruction
- usually LA
- antibiotics for cartilage
presentation of a temporal bone fracture
- injury mechanism
- hearing loss
- facial palsy
- vertigo
- CSF leak
- associated injuries
examination of a temporal bone fracture
- bruising behind ear
- condition of TM and ear canal
- VII
- hearing test
what are the classifications of temporal bone fractures
- longitudinal vs transverse
- otic capsule involved
- otic capsule spared
features of a longitudinal fracture
- lateral blows
- fracture line parallels the long axis of the petrous pyramid
- bleeding from external canal due to laceration of skin and ear drum
- haemotympanum
- ossicular chain disruption
features of a transverse fracture
- frontal blows
- fracture at right angles to the long axis of the petrous pyramid
- can cross the internal acoustic meatus causing damage to auditory and facial nerves
- sensorineural hearing loss due to damage to 8th cranial nerve
- facial nerve palsy and vertigo
management of temporal bone fractures
- often delayed as polytrauma
- may need facial nerve decompression
- may need to manage CSF leak
- may need hearing restoration
treatment for sudden sensorineural hearing loss
steroids 1mg/kg and consider intratympanic treatment
if a knife perforates the aerodigestive tract what are the associated symptoms
- dyspnoea
- hoarseness
- dysphonia
what is involved in zone 1 for knife wounds
- trachea
- oesophagus
- thoracic duct
- thyroid
- vessels
- spinal cord
zone 2 for knife wounds
- larynx
- hypopharynx
- CN 10, 11, 12
- vessels
- spinal cord
investigations for a neck wound
- FBC
- CXR
- CT angiogram
- MR angiogram?
- laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy
- angiography
what can cause a deep neck space infection
extension of infection from tonsil or oropharynx into deeper tissues
presentation of deep neck space infection
- sore throat
- unwell
- limited neck movement
management of deep space neck infection
- admit
- IV access, bloods
- fluid rehydration
- IV antibiotics
presentation of a maxillary fractures
- pain
- decreased visual acuity
- diplopia
- hypoaesthesia in infraorbital region
- periorbital ecchymosis
- oedema
- enopthalmos
- restriction of occular movement
treatment for airway obstruction with infective, foreign bodies
- A, B, C
- oxygen high flow
- heliox
- steroid
- adrenaline
- flexible fibre - optic endoscopy
- secure airway with ET tube/tracheostomy
- treat underlying pathology
