ENT emergencies Flashcards
Trauma:
-what is the primary concern in facial, head, or neck trauma?
-main concern is maintaining the airway. –avoid nasal tracheal intubation, consider Endotracheal intubation, laryngeal mask airway, cricothyroidotomy
Why is it important to avoid NG tubes or any tube in the nose until the extent of head, facial, or neck truma is determined?
may have facial fxs that lead to NG tube placement in the brain.
PE findings that will hlep reveal 90% of ENT fx:
- nose
- ears
- oral and mandibular
Nose:
- csf rhinorrhea
- septal hematoma
- nasal fx
Ears:
- subperichondral (auricular) hematoma
- hemotympanum
- battle sign
Oral and Mandibular:
- mandibular deviation
- malocclusion of teeth paresthesia
- tongue blade test
How do we determine CSF Rhinorrhea on PE?
What is the significance of CSF rhinorrhea?
- halo sign; drop of blood on linen and see dark circle of blood with light halo ring surrounding it. This means there is CSF in the blood.
significance: direct communication with the CNS exists d/t disruption of the bony barrier and tear in the dura, significant risk for CNS infection
How do you differentiate between clear nasal discharge and CSF?
clinical hx
filter paper and look for halo sign
test for glucose with glucose oxidase paper
Septal Hematoma:
- cause?
- tx
- what type of fx many result in formation of bilateral hematomas?
cause:
- trauma to anterior nasal septum in adults
- simple falls or minor altercations in children
Tx:
- drain and pack
- abx (augmentin…if abscess suspected IV clindamycin and admit to hospital)
Cartilage fx may result in formation of bilateral hematoma.
Complications from not drainingn a septal hematoma?
- saddle nose deformity
- septal perforation
- septal abscess
What is the most commonly fx bone in the face?
nose!! :)
Nasal fx
- dx
- sx
- PE
- tx
dx: based upon PE.
Sx: edematous and tender
PE: look for displacment, crepitus, and epistaxis
Tx: manage 2-10days post injury to allow for reduction of swelling.
-if significant displacement of nasal fx on films need ENT consult.
Auricular hematoma
- cause
- tx
cause: direct trauma to auricle, caused by separation of the cartilage from the perichondrium resulting in avascular necrosis
Tx: drain within 7days, compression dressing, daily follow up for a few days, abx to cover staph.
Cauliflower Ear
-cause
Ear laceration
-tx
Causes: failure to drain hematoma
- stimulation of cartilage growth
- laceration through cartilage
- infection
- high piercings
Ear Laceration:
Tx: can do single layer closure through skin and perichondrium but not the cartilage.
-pressure to dressing to prevent hematoma
-close follow up
-can use posterior auricular block for anesthesia
What are some findings of middle ear injury?
- hemotympanum
- amber/clear middle ear effusion
- otorrhea
- hearing deficit by weber and rinne tuning fork tests
- nystagmus
- ataxia
- retroauricular hematoma (battle sign)
- facial nerve deficit may be a sign of basilar skull fx or associated with a middle ear injury
Basilar Skull Fx
- fx of what bones?
- what three signs are most evident?
fx in the temporal, occipital, sphenoid, and ethmoid bones
-battle sing (6-12hrs), hemotympanum, raccoon eyes
ottorhea:
- must evaluate for?
- what do you do if penetrating FB?
must evaluate for blood or CSF
if penetrating FB leave the FB there until further evaluation with imaging.
Mandibular fx:
- dx
- tx
Dx:
- tongue blade test: bite down and twist, if mandibular fx cannot do this.
- XRAY or CT
Tx:
-airway management, hemostasis, and surgery consult.
Blunt trauma to neck
- first thing you need to do when this pt comes in?
- MC cauase
first thing you need to do is determine if the airway and patient are stable or unstable, pt may deteriorate rapidly..impending airway obstruction
MC Cause: MVA
Laryngeal trauma management
- follow ATLS principles
- tracheostomy in pts exhibity resp distress, call ENT or surgeon.
- those w/ no acute breathing difficulties get a hx, PE, and serial flexible fiberoptic exams to differentiate the need for medical/surgical management.
Nasal FB
- sx
- dx
- tx
- typical pt
sx: unilateral rhinitis, foul odor, epistaxis, pain
dx: direct vizualization or Xray
Tx: remove w/ forceps or suction
Patient: toddler with unilateral foul smelling nasal discharge.
Epistaxis
-MC site of bleeding
-why are psoterior bleeds more severe?
0
MC site is Kiesselbachs plexus
Posterior more severe and harder to treat d/t arterial involvement (sphenopalatine artery)
Causes of Epistaxis
- local
- systemic
Local: trauma, epistaxis digitorum*, FB, medications, vascular malformation, chronic sinusitis, neoplasms, polyps, irritants.
Systemic:
-hemophilia, HTN, leukemia, liver dz, anticoagulants*, blood dyscrasias
Management of Epistaxis
blow nose to clear clots
spray with topical vasoconstrictor (afrin)
lean forward and pinch nares together for at least 20minutes continuously
examine and locate site of bleeding.
**This works for anterior epistaxis only, posterior nose bleed requires more invasive procedure.
May require silver nitrate cautery, if cautery is unsuccessful use nasal tampon or packing. Leave in place for 48hrs, follow up in 24-48hrs.
WHat are some risks to nasal packing?
WHo performs posterior packing?
-if packing is too tight necrosis may occur. Toxic shockk syndrome.
Not you, you call the ENT. most of these patients are admitted to the hospital
Auricular cellulitis
-MC cause
-population at high risk
-
MC cause: Staph aureus and pseudomonas
Population at high risk - DM, difficult to tx d/t poor blood supply
Barotrauma
- etiologies
- tx
Etiologies:
- flying
- diving
- blast injuries
Tx:
- supportive
- keep ear dry
- recheck in 4weeks to determine if TM is healed
- audiometry evaluation
