ENT emergencies Flashcards
what is looked for in a nasal trauma examination?
Bruising, Swelling
Tenderness
Deviation
Epistaxis
Infraorbital sensation
CNs
how is a nasal fracture diagnosed?
Diagnosis clinical – investigations superfluous
Based on deviation / cosmesis
Breathing
what are some complications of a nasal fracture?
Epistaxis – particularly ant ethmoid artery
CSF leak , meningitis
Anosmia – cribriform plate fracture
how is a nose bleed managed?
Local Treatment
External Pressure to Nose
Ice
Cautery
Nasal Packing
how is an acute nose bleed managed in a hospital setting?
Resuscitate on arrival if necessary
Arrest/slow flow: pressure, ice, topical vasoconstrictor +/- LA (Lignocaine + adrenaline, Co-phenylcaine)
Remove clot: suction, nose blowing
Anterior Rhinoscopy
Cautery / pack
30 degree rigid nasendoscopy
Cauterise vessel: silver nitrate / diathermy
when does a CSF leak need repaired?
if not settled within 10 days
what are some ear emergencies?
Pinna Haematoma
Ear Lacerations
Temporal bone fractures
Sudden sensorineural hearing loss
how is a pinna haematoma treated?
Aspirate (usually done first but only once)
Incision and drainage
Pressure dressing
No good evidence which technique is best.
what are the signs of a temporal bone fracture?
bruising- battle sign (bruising and erythema behind the ear)
check the condition of the TM, ear canal and CN VII
what are the different classifications of a temporal bone fracture?
otic capsule involved (damage to cochlear and vestibula) (transverse)
or
optic capsule spared (longitudinal)
what are the features of a longitudinal temporal bone fracture?
80%
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 (conductive deafness)
Ossicular chain disruption (conductive deafness)
Facial palsy (20%)
CSF otorrhoea
what are the features of a transverse temporal fracture?
20%
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 (50%) & Vertigo
what is the management of a temporal bone fracture?
Often delayed as polytrauma
May need facial nerve decompression , If no recovery and EMG studies
May need to manage CSF leak , most settle but may need repair
May need hearing restoration, Either hearing aid or ossiculoplasty
what are some possible causes of conductive hearing loss?
Fluid
TM Perforation
Ossicular problem
is sudden sensorineural hearing loss emergent?
yes
how is sensorineural hearing loss diagnosed?
webers test
how is sudden sensorineural hearing loss treated?
Steroids 1mg/kg and consider intratympanic treatment
how is a foreign body in the ear managed?
Can usually wait until urgent clinic for removal
Except watch batteries – remove immediately
Live animals – drown with oil can be removed next day
what are some examples of neck emergencies?
Penetrating : Knife / GSW / MVA
Industrial accidents
Household accidents
Blunt
-MVA
-Sports injuries (clothesline tackle)
where is zone 1 classification?
Bottom of the neck
Trachea
Oesophagus
Thoracic duct
Thyroid
Vessels – brachiocephalic, subclavian, common carotid, thyrocervical trunk
Spinal cord
where is zone 2 classification
middle of neck
Larynx
Hypopharynx
CN 10,11,12
Vessels – carotids, internal jugular
Spinal Cord
where is zone 3 classification?
top of the neck
Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord
what is the management of a neck stab wound?
FBC, G&S / XM
AP/Lateral neck - ?FB
CXR – haemo-pneumothorax, emphysema
CT Angiogram – vascular, pseudoaneurysm, laryngeal, aerodigestive tract ?
MR Angiogram ?
Urgent exploration – expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
Laryngoscopy, bronchoscopy, pharyngoscopy, and oesophagoscopy
Angiography – embolize, occlude
what are the features deep neck space infection?
Extension of infection from tonsil or oropharynx into deeper tissues
History: sore throat, unwell, limited neck movement
Examination: Febrile, trismus, red / tender neck
what are the features of quinsy?
different to tonsilitis
unilateral
change in voice
trismus
an abscess that forms between a tonsil and the wall of throat
how is a deep neck space infection managed?
Admit
Iv access, bloods,
Fluid rehydration
Intravenous antibiotics, such as co-amoxiclav or clindamycin
May need theatre for incision & drainage
Airway compromise may be imminent so need to drain infection
