ENT Emergencies Flashcards
What mechanisms of injury cause nasal trauma
Fighting, sports injuries, falls
Important questions to ask a patient with nasal trauma
When it occurred
Any loss of consciousness
Nose bleeding
Effect on breathing
Signs of nasal trauma
Bruising, swelling
Tenderness
Deviation
Epistaxis
Management of septal haematoma
Must be drained to prevent nasal collapse
Consequence of nasal haematoma
Stops blood supply getting to the cartilage
What must be ruled out in nasal trauma
Septal haematoma
Management of nasal trauma
Review in ENT clinic 5-7 days post-injury
Consider manipulation in <3 weeks
What artery is commonly damaged in nasal trauma leading to epistaxis
Anterior ethmoid artery
What is epistaxis
Nose bleed
Name some local causes of epistaxis
Idiopathic, trauma, foreign bodies, inflammation, tumour
Name some systemic causes of epistaxis
Drugs, clotting abnormalities, haemophilia, leukaemia, thrombocytopenia
Name some drugs that can cause epistaxis
Snorting cocaine
Aspirin, DOACs, warfarin
Commonest site of bleeding in epistaxis
Little’s area
What is little’s area
Place on the anterior septum where a number of vessels anastomose
What vessels are found in little’s area
Anterior ethmoid, posterior ethmoid, sphenopalatine, great palatine, superior labial
MOA of tranexamic acid
Inhibits the breakdown of fibrin clots
Systemic management of epistaxis
Tranexamic acid, reversal of anticoagulation
First aid management of a nose bleed
Squeeze soft part of nostrils together and tilt head forwards
Spit out blood rather than swallowing it
Direct therapy of persistent nose bleeds
Silver nitrate cautery if there’s an identifiable anterior bleeding point
Surgical management of epistaxis
Endoscopic sphenopalatine artery ligation
Indirect management of epistaxis
Nose packs
Foley catheters to compress difficult to identify bleeding points
What causes a CSF leak
Fracture through the cribiform plate
What does the cribiform plate form
The roof of the nasal cavity
How does a CSF leak present
Persistent clear rhinorrhoea
Headache
When does a CSF leak need repairing
If it hasn’t resolved spontaneously within 10 days
Why do we not initially give antibiotics to a patient with a CSF leak
Can mask meningitis
What is a pinna haematoma caused by
Shearing forces applied to the auricle
Who commonly presents with pinna haematoma
Rugby players and boxers
What is a complication of an untreated pinna haematoma
Avascular necrosis
Pathophysiology of pinna haematoma
Following trauma the perichondrial blood vessel tears, resulting in a haematoma between the auricular cartilage and the overlying perichondrium
What is cauliflower ear
Fibrocartilage overgrowth secondary to a pinna haematoma
Management of a pinna haematoma
Aspiration, incision and drainage OR pressure dressing
What are the 2 main classifications of temporal bone fracture
Longitudinal or transverse
What is the most common type of temporal bone fracture
Longitudinal fractures
What usually causes a longitudinal temporal bone fracture
A lateral blow to the head
What is a longitudinal temporal bone fracture
Fracture line is parallel to the long axis of the petrous pyramid
Complications of a longitudinal fracture of the temporal bone
Bleeding from external canal due to laceration of skin and eardrum
Hemotympanum
Ossicular chain disruption
Facial palsy
CSF otorrhoea
What is hemotympanum
Blood in the middle ear space
What causes transverse fractures
Fronto-occipital head trauma
What is a transverse temporal bone fracture
Fracture at right angle to the long axis of the petrous pyramid
Complications of a transverse temporal bone fracture
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
Important questions to ask a patient with a temporal bone fracture
Injury mechanism
Symptoms: hearing loss, facial palsy (immediate or delayed), CSF leak, vertigo, associated injuries
Sign of a temporal bone fracture
Battle sign
What is battle sign
Bruising over mastoid, indicates base of skull fracture
Investigation for temporal bone fracture
CT
Management of temporal bone fracture
Mostly conservative
Management of conductive hearing loss following trauma
May need facial nerve decompression
May need hearing restoration- hearing aid, ossiculoplasty
Management of sudden sensorineural hearing loss following trauma
Weber test, high dose steroids, consider intratympanic treatment
Management of foreign bodies in the ear and nose
Can usually wait until clinic for removal
What is the exception to waiting to remove foreign bodies in the ear and nose
Watch batteries
How do we manage swallowed foreign bodies
Impacted body must be removed
Who is more likely to get neck trauma
Young males
Causes of penetrating knife trauma
Knife crime
Industrial or household accidents
Causes of blunt neck trauma
Motor vehicle accident
Sporting injuries: clothesline tackle
How do we classify neck trauma
Zone 1,2 and 3
Contents of zone 1 of the neck
Trachea, oesophagus, thoracic duct, thyroid, vessels, spinal chord
Vessels in zone 1 of the neck
Brachiocephalic, subclavian, common carotid, thryocervical trunk
Contents of zone 2 of the neck
Larynx, hypopharynx, CN 5,6,7, vessels, spinal chord
Vessels in zone 2 of the neck
Carotids, internal jugular
Contents of zone 3 of the neck
Pharynx, cranial nerves, vessels, spinal chord
Vessels in zone 3 of the neck
Carotid, internal jugular vein, vertebral
ABCDE signs of neck trauma
Stridor, hoarseness, use of accessory muscles
Investigations in neck trauma
x-rays, CT angiogram, MRI, laryngoscopy, bronchoscopy, oesophagoscopy
What is a deep neck space infection
Extension of infection from tonsil or oropharynx into deeper tissues
Symptoms of a deep neck space infection
Sore throat, generally unwell, limited neck movement
Signs of a deep neck space infection
Febrile, trismus, red/tender neck
What is another name for trismus
Lockjaw
Management of a deep neck space infection
Rehydration
IV antibiotics
Incision and drainage of big abscesses
IV antibiotics used to manage deep neck space infections
Co-amoxiclav or clindamycin
Complication of deep neck space infection
May extend into mediastinum through fascial compartments
What makes the larynx of a neonate different
Obligate nasal breathers
Large tongues
Small, soft larynx
Narrow subglottis
Symptoms of airway obstruction
SOB on exertion or at rest
Choking
Coughing
Inability to complete a sentence
Signs of airway obstruction
Sternal/subcostal recession
Tracheal tug
Pyrexia
Cyanosis
Stridor/stertor
What is another name for stertor
Snoring
What is the last option management of airway obstruction
Tracheostomy
Name some causes of ear lacerations
Blunt trauma
Avulsion
Dog bites
Management of ear lacerations
Debridement, closure
Usually under local
Complication of ear laceration
Tissue loss
Usual mechanism of injury for maxillary fractures
High energy blunt force trauma to the facial skeleton
Clinical presentation of orbital floor fractures
Bruising around the eye, eyes look sunken in, restriction of ocular movement, swelling
