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Y2 ENT > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

1
Q

What is important to check when a patient presents with nasal trauma

A

Deviation
Epistaxis
Nasal septum
Breathing

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2
Q

What are the complications of nasal trauma

A

CSF leak
Septal haematoma -> necrosis of cartilage
Epistaxis
Anosmia (loss of smell)

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3
Q

Why is it important to check the nasal septum when a patient presents with nasal trauma

A

To check for septal haematoma

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4
Q

What is septal haematoma

A

Bleeding under the perichondrium lining the septal cartilage, commonly caused by nasal trauma

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5
Q

Why is septal haematoma problematic

A

It stops blood supply getting to the septal cartilage since the cartilage gets its blood supply from the mucosa (the haematoma separates the mucosa and cartilage)

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6
Q

What can occur if septal haematoma is not treated early enough

A

septal perforation and necrosis
resulting in saddle-nose deformity

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7
Q

Management of septal haematoma

A

Urgent referral to ENT
Emergency incision & drainage

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8
Q

Management of suspected nasal fracture

A

Review nasal fracture in ENT clinic 5-7 days post-injury (if seen too early, it may not be visible)
Consider closed reduction if needed

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9
Q

Management for ear lacerations

A

Debridement
Closure under local anaesthetic
Cover with antibiotics if cartilage is exposed

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10
Q

What is CSF leak

A

Cerebral spinal fluid from the brain leaks through the cribriform plate and out of the nose

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11
Q

Symptoms of CSF leak

A

Headache
Persistent clear rhinorrhea

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12
Q

Management of CSF leak

A

Often settles spontaneously
Repair if does not resolve within 10 days
Do not give antibiotics initially

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13
Q

Causes of epistaxis

A

Idiopathic
Trauma
Foreign bodies
Tumour
Alcohol
Drugs (warfarin, aspirin, antiplatelets..etc)
Coagulopathy
Leukaemia
Thrombocytopaenia
Hereditary hemorrhagic telangiectasia
GPA

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14
Q

What drugs can cause epistaxis

A

Antiplatelets (clopidogrel, ticagrelor..etc)
Anticoagulants (warfarin, heparin, apixaban..etc)
Aspirin (both a NSAID and anti platelet)
NSAID

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15
Q

Examples of antiplatelets

A

Clopidogrel
Prasugrel
Ticagrelor

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16
Q

Examples of anticoagulants

A

Warfarin
Heparin
Apixaban
Rivaroxaban
Dabigatran

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17
Q

Apixaban, rivaroxaban and dabigatran are

A

DOAC - direct oral anticoagulants

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18
Q

Which has a higher bleeding risk - warfarin or DOAC

A

Warfarin

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19
Q

If a patient with epistaxis has hypertension, they are likely to

A

have prolonged bleeding

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20
Q

Where is the most common site of epistaxis

A

Kiesselbach’s plexus - at anterior septum

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21
Q

What are the arteries that contribute to the Kiesselbach’s plexus

A

anterior ethmoid
posterior ethmoid
sphenopalatine
great palatine
septal branch of superior labial

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22
Q

Sphenopalatine artery is a branch of

A

Maxillary artery

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23
Q

Greater palatine artery is a branch of

A

Maxillary artery (descending palatine branch)

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24
Q

Maxillary artery is a branch of

A

External carotid artery

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25
Q

Superior labial artery is a branch of

A

Facial artery

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26
Q

Facial artery is a branch of

A

External carotid artery

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27
Q

Anterior and posterior ethmoidal arteries are branches of

A

Ophthalmic artery

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28
Q

Ophthalmic artery is a branch of

A

Internal carotid artery

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29
Q

Name A-E

A

A- Anterior ethmoidal artery
B- Posterior ethmoidal artery
C- Septal branch of superior labial artery
D- Sphenopalatine artery
E- Greater palatine artery

30
Q

Anterior bleeding of the nose is usually due to rupture of which vessels and what usually causes it

A

Anterior and posterior ethmoid arteries
mostly due to trauma

31
Q

Posterior bleeding of the nose is usually due to rupture of which vessel and what usually causes it

A

Sphenopalatine arteries
Mostly due to underlying pathologies such as hypertension

32
Q

Management of epistaxis

A

Take a brief history - ask about anticoagulants/antiplatelets
1. Direct compression of the cartilaginous part of nose, patient leaning forward, spitting out into a bowl, ice pack
2. Silver nitrate nasal cautery if there is a visible anterior bleeding point
3. Nasal packs or Foley catheters if bleeding point difficult to identify (posterior bleeding / heavy bleeding )
4. Sphenopalatine artery ligation for posterior bleeds

33
Q

Why do patients with epistaxis need to pinch their nose while leaning forward

A

To prevent blood from entering the oral cavity / pharynx
Swallowing blood can cause vomiting and stomach irritation

34
Q

When is nasal packing used for epistaxis

A

If it is posterior bleeding which is hard to identify
Heavy bleeding

35
Q

When is sphenopalatine artery ligation indicated

A

Posterior bleeding
Uncontrollable severe bleeding

36
Q

What is pinna haematoma

A

Perichondrial blood vessels tear due to trauma resulting in bleeding between the auricular cartilage and overlying perichondrium

37
Q

Injury mechanicm of pinna haematoma

A

Shearing type injuries to the auricle e.g. in rugby players and boxers

38
Q

What can pinna haematoma lead to

A

Disrupt blood supply to the cartilage -> avascular necrosis of pinna
-> Cauliflower deformity of the ear

39
Q

Appearance of pinna haematoma

A
40
Q

Management of pinna haematoma

A

Urgent aspiration, drainage, decompression of the haematoma within 24 hours of injury

41
Q

Which bone of the base of the skull is the most commonly fractured

A

Temporal bone

42
Q

Types of temporal bone fracture

A

Longitudinal
Transverse

43
Q

The classification of longitudinal / transverse depends on

A

the relation of the fracture with the axis of the ear canal

44
Q

Which type of temporal bone fracture is the most common

A

Longitudinal fracture

45
Q

Injury mechanism of longitudinal fracture

A

Lateral blow to the head

46
Q

Symptoms of basal skull fracture

A

Reduced consciousness
Battle’s sign - bruising of the mastoid
CSF leak
Epistaxis / bleeding from ear
Haemotympanum
Facial nerve palsy

47
Q

What is Battle’s sign

A

Bruising over the mastoid process, indicating base of skull fracture

48
Q

What is haemotympanum

A

Blood behind the tympanic membrane

49
Q

Investigations for basal skull fracture

A

CT
Hearing test, facial nerve examination

50
Q

Complications of longitudinal temporal bone fracture

A

Haemotympanum -> Conductive hearing loss
Disruption of ossicles -> conductive hearing loss
Facial palsy
CSF otorrhea (leak from ear)

51
Q

Complications of transverse temporal bone fracture

A

Can cross the internal acoustic meatus and damage auditory and facial nerves
Sensorineural hearing loss
Facial palsy
Vertigo

52
Q

Which type of temporal bone fracture more commonly presents with facial nerve palsy

A

Transverse fracture

53
Q

For neck trauma, the neck is divided into

A

3 zones

54
Q

What are the borders of zone 1 for neck trauma

A

From the sternal notch -> cricoid process

55
Q

What structures are at risk of being damaged at zone 1

A

Trachea
Recurrent laryngeal and vagus nerves
Oesophagus
Subclavian artery and vein
Brachiocephalic vein
Proximal part of common carotid artery
Jugular veins
Spinal cord

56
Q

What are the borders of zone 2 for neck trauma

A

Cricoid process -> angle of mandible

57
Q

What structures are at risk of damage in zone 2

A

Larynx
Pharynx
Vagus nerve
Distal part of common carotid artery
Proximal part of internal and external carotid arteries
Jugular veins
Spinal cord

58
Q

What are the borders of zone 3 of neck trauma

A

Angle of mandible -> base of skull

59
Q

What structures are at risk of damage in zone 3

A

internal and external carotid arteries
Jugular veins
Cranial nerves IX - XII
Spinal cord

60
Q

Investigations for neck injury

A

Ask mechanism of injury
Assess if there is any CNS problems
ABCDE
Haemodynamically stable ?

61
Q

Management for patients with neck injury that are haemodynamically stable

A

CT angiogram -> surgical exploration / angiography / oesophagram / endoscopy / laryngoscopy

62
Q

Management for patients with neck injury that are not haemodynamically stable

A

immediate surgery

63
Q

What are deep neck space infections

A

When infections from the oropharyngeal region spreads into fascial planes

64
Q

What are the 2 types of deep neck space infections

A

Parapharyngeal abscess
Retropharyngeal abscess

65
Q

What is parapharyngeal abscess

A

When infection spreads to the space posterolateral to nasopharynx

66
Q

What is retropharyngeal abscess

A

When infection spreads to the space anterior to pre vertebral fascia

67
Q

Symptoms of deep neck space infections

A

Severe sore throat
Unwell
Neck stiffness
Trismus
Voice changes
Fever

68
Q

What are the red flag symptoms for suspected DNSI patients that may indicate they can quickly decompensated

A

Severe neck pain or stiffness
Airway compromised - stridor/ drooling/ dyspnoea

69
Q

Investigations for DNSI

A

Bloods - extremely high inflammatory markers
CT with IV contrast

70
Q

Management for DNSI

A

IV antibiotics (broad spectrum) - co-amoxiclav/clindamycin
IV fluid resuscitation
Oxygen / intubation
Surgical drainage

71
Q

What antibiotics are used for DNSI

A

Co-amoxiclav or clindamycin

Y2 ENT (7 decks)

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