ENT emergencies Flashcards
What clinical emergency should be excluded in a case of nasal trauma?
Septal haematoma
How is a nasal fracture diagnosed?
Clinical diagnosis based on deviation and cosmesis
What is a septal haematoma?
A break in and underneath bleed of the mucosal lining in the nose
What are the more well known complications of a nasal fracture?
Epistaxis
CSF leak
Meningitis
Anosmia - cribriform plate fracture
What are the three main arteries involved in epistaxis?
Sphenopalatine artery
Ethmoid arteries
Greater palatine artery
What are the first aid measures for epistaxis?
External pressure to nose
Ice
Cautery
Nasal packing
How long should nasal fractures be left until they are re-assessed?
1 week to allow swelling and bruising to settle
Key point - no longer than 3 weeks
What are some systemic treatment options for epistaxis?
Tranexamic acid
Reversal of anticoagulants
Correction of clotting abnormality
At what point does a CSF leak need to be repaired?
If not settled within 10 days
What are the three most known ear emergencies?
Pinna haematoma
Temporal bone fracture
Sudden sensorineural hearing loss
How is a pinna haematoma managed?
Aspiration and incision / drainage
Pressure dressing
What are the signs of a temporal bone fracture on examination?
Bruising - ‘battle sign’
Hearing test deviation
The condition of the TM / ear canal
What type of fracture is most commonly seen in temporal bones?
Longitudinal fractures from lateral blows
What is haemotympanum?
Blood in the middle ear cavity
What test should be done if a patient presents with sudden sensorineural hearing loss?
Weber test
How is sudden sensorineural hearing loss managed?
Steroids - 1mg/kg
Consider intratympanic treatement
What foreign body must be removed as soon as possible?
Batteries
How are live animals in the ear canal extracted?
Drowned with oil then removed the following day
How does a deep neck space infection commonly present?
Febrile
Sore throat
Generally unwell
Limited neck movement
Red / tender neck
Trismus
How should a deep neck space infection be managed?
Admission
IV access and bloods
Fluid rehydration
IV antibiotics
What are concerning symptoms when dealing with temporal bone fractures?
CN palsies
Hearing loss
What ENT emergency is very important to recognise immediately?
Airway obstruction
How is supraglottitis managed?
Similar to airway obstruction with the addition of :
Broad spectrum antibiotic
Airway plan
Senior help
In a septic patient that shows a voice / airway change with normal tonsils what should be assessed for?
Supraglottitis
How should airway obstruction be managed?
ABC - resuscitation
High flow oxygen
Heliox
Steroids / adrenaline
What can be used with caution in airway obstruction due to the possibility of aggravating a precarious airway?
Flexible fibre-optic endoscopy
How can an airway be secured in airway obstruction?
ET tube
Tracheostomy
What is a key sign of quinsy?
Deviated uvula
How does quinsy present?
Sore throat
Struggling to open mouth
Unilateral
Change in voice
Trismus
What is the main management of quinsy?
Fluids and analgesia
Drainage - needle / I+D
Which patients are most at risk of swallowing foreign bodies in the airways?
Children
