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otolaryngology > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

1
Q

What mechanisms of injury cause nasal trauma

A

Fighting, sports injuries, falls

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2
Q

Important questions to ask a patient with nasal trauma

A

When it occurred
Any loss of consciousness
Nose bleeding
Effect on breathing

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3
Q

Signs of nasal trauma

A

Bruising, swelling
Tenderness
Deviation
Epistaxis

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4
Q

Management of septal haematoma

A

Must be drained to prevent nasal collapse

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5
Q

Consequence of nasal haematoma

A

Stops blood supply getting to the cartilage

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6
Q

What must be ruled out in nasal trauma

A

Septal haematoma

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7
Q

Management of nasal trauma

A

Review in ENT clinic 5-7 days post-injury
Consider manipulation in <3 weeks

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8
Q

What artery is commonly damaged in nasal trauma leading to epistaxis

A

Anterior ethmoid artery

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9
Q

What is epistaxis

A

Nose bleed

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10
Q

Name some local causes of epistaxis

A

Idiopathic, trauma, foreign bodies, inflammation, tumour

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11
Q

Name some systemic causes of epistaxis

A

Drugs, clotting abnormalities, haemophilia, leukaemia, thrombocytopenia

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12
Q

Name some drugs that can cause epistaxis

A

Snorting cocaine
Aspirin, DOACs, warfarin

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13
Q

Commonest site of bleeding in epistaxis

A

Little’s area

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14
Q

What is little’s area

A

Place on the anterior septum where a number of vessels anastomose

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15
Q

What vessels are found in little’s area

A

Anterior ethmoid, posterior ethmoid, sphenopalatine, great palatine, superior labial

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16
Q

MOA of tranexamic acid

A

Inhibits the breakdown of fibrin clots

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17
Q

Systemic management of epistaxis

A

Tranexamic acid, reversal of anticoagulation

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18
Q

First aid management of a nose bleed

A

Squeeze soft part of nostrils together and tilt head forwards
Spit out blood rather than swallowing it

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19
Q

Direct therapy of persistent nose bleeds

A

Silver nitrate cautery if there’s an identifiable anterior bleeding point

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20
Q

Surgical management of epistaxis

A

Endoscopic sphenopalatine artery ligation

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21
Q

Indirect management of epistaxis

A

Nose packs
Foley catheters to compress difficult to identify bleeding points

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22
Q

What causes a CSF leak

A

Fracture through the cribiform plate

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23
Q

What does the cribiform plate form

A

The roof of the nasal cavity

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24
Q

How does a CSF leak present

A

Persistent clear rhinorrhoea
Headache

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25
Q

When does a CSF leak need repairing

A

If it hasn’t resolved spontaneously within 10 days

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26
Q

Why do we not initially give antibiotics to a patient with a CSF leak

A

Can mask meningitis

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27
Q

What is a pinna haematoma caused by

A

Shearing forces applied to the auricle

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28
Q

Who commonly presents with pinna haematoma

A

Rugby players and boxers

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29
Q

What is a complication of an untreated pinna haematoma

A

Avascular necrosis

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30
Q

Pathophysiology of pinna haematoma

A

Following trauma the perichondrial blood vessel tears, resulting in a haematoma between the auricular cartilage and the overlying perichondrium

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31
Q

What is cauliflower ear

A

Fibrocartilage overgrowth secondary to a pinna haematoma

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32
Q

Management of a pinna haematoma

A

Aspiration, incision and drainage OR pressure dressing

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33
Q

What are the 2 main classifications of temporal bone fracture

A

Longitudinal or transverse

34
Q

What is the most common type of temporal bone fracture

A

Longitudinal fractures

35
Q

What usually causes a longitudinal temporal bone fracture

A

A lateral blow to the head

36
Q

What is a longitudinal temporal bone fracture

A

Fracture line is parallel to the long axis of the petrous pyramid

37
Q

Complications of a longitudinal fracture of the temporal bone

A

Bleeding from external canal due to laceration of skin and eardrum
Hemotympanum
Ossicular chain disruption
Facial palsy
CSF otorrhoea

38
Q

What is hemotympanum

A

Blood in the middle ear space

39
Q

What causes transverse fractures

A

Fronto-occipital head trauma

40
Q

What is a transverse temporal bone fracture

A

Fracture at right angle to the long axis of the petrous pyramid

41
Q

Complications of a transverse temporal bone fracture

A

Can cross the internal acoustic meatus and cause damage to the auditory and facial nerves
Sensorineural hearing loss due to damage of CN8
facial nerve palsy
Vertigo

42
Q

Important questions to ask a patient with a temporal bone fracture

A

Injury mechanism
Symptoms: hearing loss, facial palsy (immediate or delayed), CSF leak, vertigo, associated injuries

43
Q

Sign of a temporal bone fracture

A

Battle sign

44
Q

What is battle sign

A

Bruising over mastoid, indicates base of skull fracture

45
Q

Investigation for temporal bone fracture

A

CT

46
Q

Management of temporal bone fracture

A

Mostly conservative

47
Q

Management of conductive hearing loss following trauma

A

May need facial nerve decompression
May need hearing restoration- hearing aid, ossiculoplasty

48
Q

Management of sudden sensorineural hearing loss following trauma

A

Weber test, high dose steroids, consider intratympanic treatment

49
Q

Management of foreign bodies in the ear and nose

A

Can usually wait until clinic for removal

50
Q

What is the exception to waiting to remove foreign bodies in the ear and nose

A

Watch batteries

51
Q

How do we manage swallowed foreign bodies

A

Impacted body must be removed

52
Q

Who is more likely to get neck trauma

A

Young males

53
Q

Causes of penetrating knife trauma

A

Knife crime
Industrial or household accidents

54
Q

Causes of blunt neck trauma

A

Motor vehicle accident
Sporting injuries: clothesline tackle

55
Q

How do we classify neck trauma

A

Zone 1,2 and 3

56
Q

Contents of zone 1 of the neck

A

Trachea, oesophagus, thoracic duct, thyroid, vessels, spinal chord

57
Q

Vessels in zone 1 of the neck

A

Brachiocephalic, subclavian, common carotid, thryocervical trunk

58
Q

Contents of zone 2 of the neck

A

Larynx, hypopharynx, CN 5,6,7, vessels, spinal chord

59
Q

Vessels in zone 2 of the neck

A

Carotids, internal jugular

60
Q

Contents of zone 3 of the neck

A

Pharynx, cranial nerves, vessels, spinal chord

61
Q

Vessels in zone 3 of the neck

A

Carotid, internal jugular vein, vertebral

62
Q

ABCDE signs of neck trauma

A

Stridor, hoarseness, use of accessory muscles

63
Q

Investigations in neck trauma

A

x-rays, CT angiogram, MRI, laryngoscopy, bronchoscopy, oesophagoscopy

64
Q

What is a deep neck space infection

A

Extension of infection from tonsil or oropharynx into deeper tissues

65
Q

Symptoms of a deep neck space infection

A

Sore throat, generally unwell, limited neck movement

66
Q

Signs of a deep neck space infection

A

Febrile, trismus, red/tender neck

67
Q

What is another name for trismus

A

Lockjaw

68
Q

Management of a deep neck space infection

A

Rehydration
IV antibiotics
Incision and drainage of big abscesses

69
Q

IV antibiotics used to manage deep neck space infections

A

Co-amoxiclav or clindamycin

70
Q

Complication of deep neck space infection

A

May extend into mediastinum through fascial compartments

71
Q

What makes the larynx of a neonate different

A

Obligate nasal breathers
Large tongues
Small, soft larynx
Narrow subglottis

72
Q

Symptoms of airway obstruction

A

SOB on exertion or at rest
Choking
Coughing
Inability to complete a sentence

73
Q

Signs of airway obstruction

A

Sternal/subcostal recession
Tracheal tug
Pyrexia
Cyanosis
Stridor/stertor

74
Q

What is another name for stertor

A

Snoring

75
Q

What is the last option management of airway obstruction

A

Tracheostomy

76
Q

Name some causes of ear lacerations

A

Blunt trauma
Avulsion
Dog bites

77
Q

Management of ear lacerations

A

Debridement, closure
Usually under local

78
Q

Complication of ear laceration

A

Tissue loss

79
Q

Usual mechanism of injury for maxillary fractures

A

High energy blunt force trauma to the facial skeleton

80
Q

Clinical presentation of orbital floor fractures

A

Bruising around the eye, eyes look sunken in, restriction of ocular movement, swelling

otolaryngology (18 decks)

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