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ENT > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

1
Q

What is the primary concern in facial, head, or neck trauma?

A

Airway

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2
Q

Avoid ________ tracheal intubation

A

Nasal

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3
Q

Besides epistaxis, what is the best way to control hemorrhage control?

A

Direct pressure

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4
Q

What is the significance of CSF rhinorrhea?

A

Direct communication with the CNS due to disruption of the bony barrier and a tear in the dura

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5
Q

How do you distinguish nasal discharge from CSF?

A

Look for “halo” sign

Test glucose

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6
Q

Septal Hematomas in Adults Occur From?

A

Significant trauma

Nasal fracture

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7
Q

Septal Hematomas in Children Occur From?

A

Simple falls

Minor altercations

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8
Q

Treatment of Septal Hematomas

A

Drain & pack

Antibiotics

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9
Q

Which antibiotic do you use for the treatment of a septal hematoma?

A

Augmentin

If abscess- Clindamycin & admit

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10
Q

What condition can result in bilateral hematomas?

A

Cartilage fracture

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11
Q

Complications if a septal hematoma is not drained

A

Saddle-nose deformity
Septal perforation
Septal abscess

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12
Q

Septal abscess may spread to:

A

Paranasal & intracranial structures

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13
Q

What is the most common fracture within the head?

A

Nasal Fracture

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14
Q

Signs & Symptoms for Nasal Fracture

A 
Edematous
Tender
Displacement
Crepitus
Epistaxis
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15
Q

What is the time frame to perform a closed reduction for a nasal fracture?

A

2-10 days

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16
Q

What causes an auricular hematoma?

A

Direct trauma to the auricle

Separation of cartilage from perichondrium

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17
Q

Treatment for Auricular Hematoma

A

Drain

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18
Q

What happens when an auricular hematoma doesn’t get drained?

A

Cauliflower Ear

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19
Q

Causes of Cauliflower Ear

A 
Failure to drain hematoma
Simulation of cartilage growth
Laceration through cartilage
Infection
High piercings
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20
Q

How can you prevent cauliflower ear?

A

Protective head gear

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21
Q

What is the management of an ear laceration?

A

Single layer closure through skin & perichondrium but not cartilage
Pressure dressing
Close follow up

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22
Q

Findings of a Middle Ear Injury

A 
Hemotympanum
Amber or clear middle ear effusion
Otorrhea
Hearing deficit
Nystagmus
Ataxia
Retroauricular hematoma
Facial nerve deficit
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23
Q

Basilar skull fractures can be secondary to a fracture in which bones?

A

Temporal
occipital
Sphenoid
Ethmoid

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24
Q

Which bone is involved in 75% of basilar skull fractures?

A

Temporal bone

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25
Q

What finding is indicative of basilar skull fracture and middle ear injury?

A

Hemotympanum

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26
Q

What is a huge sign of a basilar skull fracture?

A

Battle sign

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27
Q

What do you need to evaluate ottorhea?

A

Whether it’s blood or CSF

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28
Q

What is the 2nd most common facial fracture?

A

Mandibular fracture

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29
Q

How to evaluate a patient with a mandibular fracture?

A 
Evaluate the bite
Tooth fractures or avulsions
Trauma of tongue
Sublingual ecchymosis
Tongue blade test
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30
Q

Management of Mandibular Fractures

A

Airway management
Hemostasis
Surgical consult

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31
Q

Workup of Mandibular Fractures

A

History
Physical Exam
Xray
CT scan

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32
Q

First steps in a blunt trauma to the neck

A

Airway stable?

Patient stable?

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33
Q

Can a patient with blunt trauma to the neck deteriorate rapidly?

A

Yes

Impending airway obstruction

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34
Q

Most common blunt injuries to the neck

A

MVA

Forward thrust

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35
Q

Initial Evaluation of Blunt Trauma to the Neck

A 
ATLS principles
Intubation hazard
Respiratory distress
Avoid cricothyroidotomies
Detailed H&P if stable
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36
Q

Important History in the Diagnosis of Laryngeal Injury

A 
Change in voice
Pain
Dyspnea
Dysphagia
Odynophagia
Hemoptysis
Inability to tolerate the supine position
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37
Q

Key Physical Exam Findings in the Diagnosis of Laryngeal Injury

A 
Respiratory rate
Stridor
Contusions, abrasions in neck skin
Subcutaneous emphysema
Tracheal deviation
Air bubbles or exposed tracheal cartilage
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38
Q

What to do with UNSTABLE patients with laryngeal injury?

A

Tracheotomy

Neck exploration

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39
Q

What to do with STABLE patients with laryngeal injury?

A

Direct laryngoscopy
CT
Bronchoscopy
Esophagoscopy

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40
Q

Medical Management of Laryngeal Injury

A 
24 hours close observation
Elevated head of bed
Voice rest
Anti-reflux meds
Serial flexible fiberoptic exams
Antibiotics for laryngeal mucosa disruption
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41
Q

Symptoms of a Nasal FB

A

Unilateral rhinitis
Foul odor
Epistaxis
Pain

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42
Q

Diagnosis of a Nasal FB

A

Direct visualization

Xray

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43
Q

Treatment of a Nasal FB

A

Removal with forceps or suction

44
Q

Where is the most common site of epistaxis?

A

Kiesselbach’s plexus

45
Q

Which nose bleeds are more severe?

A

Posterior bleed

46
Q

Possible Underlying Causes of Local Epistaxis

A 
Trauma
Epistaxis digitorum
FB
Medications
Vascular malformation
Chronic sinusitis
Neoplasm
Polyps
Irritants
47
Q

Possible Underlying Causes of Systemic Epistaxis

A 
Hemophilia
Hypertension
Leukemia
Liver disease
Anticoagulants
Blood dyscrasias
48
Q

Initial Management of Epistaxis

A

Blow nose to clear clots
Spray topical vasoconstrictor
Lean forward and direct compression for 20 minutes
Examine nose with nasal speculum

49
Q

Is an anterior or posterior bleed more common?

A

Anterior

50
Q

Is an anterior or posterior bleed more serious?

A

Posterior

51
Q

Steps to Stopping Epistaxis

A

Direct Compression
Cautery
Nasal packing or nasal tampon

52
Q

How soon should you follow up with a patient after nasal packing or nasal tampon is placed?

A

24-48 hours

53
Q

What can happen if nasal packing is too tight?

A

Necrosis

54
Q

Who should place posterior packing?

A

ENT

55
Q

Should patients with a posterior bleed be admitted or sent home?

A

Admitted

56
Q

Epistaxis Complications

A 
Severe bleeding
Shock
Sinusitis
OM
Pressure necrosis
Toxic Shock Syndrome
57
Q

What is the most common etiology of auricular cellulitis?

A

S. aureus

Pseudomonas

58
Q

Which patients are at a high risk for auricular cellulitis?

A

Diabetics

59
Q

Etiologies for Barotrauma

A

Flying
Diving
Blast injuries

60
Q

Treatment for Barotrauma

A

Supportive
Keep ear dry
Recheck in 4 weeks
Audiometry evaluation

61
Q

What is the most common cause of TM rupture?

A

Infection

62
Q

Treatment for TM Rupture

A

Keep ear dry until TM healed
Most heal spontaneously
Antibiotic drops

63
Q

Antibiotics for TM Rupture

A

Ofloxicin drops

Oral antibiotics

64
Q

Which antibiotics are contraindicated in a TM rupture and why?

A

Gentamicin
Neomycin sulfate
Tobramycin
Ototoxicity

65
Q

Presentation of Epiglottitis

A 
Drooling
Fever
Hoarseness
Dysphagia
Stridor
66
Q

Evaluation of Epiglottitis

A

Diagnosis clinical
Lateral xray?
Call ENT or surgeon

67
Q

Treatment of Epiglottitis

A

Emergent ENT referrel
IV antibiotics
Intubation

68
Q

Common Bugs of Epiglottitis

A 
H. flu type B
Strep pneumo
Strep agalactiae
Staph aureus
Strep pyogenes
M. cat
69
Q

What is the main characteristic of epiglottitis?

A

Thumb print sign

70
Q

Presentation of Peritonsillar Abscess

A 
Severe unilateral throat pain
Fever
Dysphagia
"Hot potato" voice
Halitosis
Neck pain
Ear pain on affected side
Headache
Trismus
71
Q

Management of Peritonsillar Abscess

A

Supportive therapy
Work up
Immediate ENT referral for I&D

72
Q

What type of supportive therapy is needed in peritonsillar abscess?

A

Airway
Fever
Pain
Hydration

73
Q

Workup for Peritonsillar Abscess

A

+/- lateral neck xray

+/- CT with contrast

74
Q

Anatomic Area of Retropharyngeal Abscess

A

Base of skull to the tracheal bifurcation

75
Q

Define Retropharyngeal Abscess

A

Deep tissue neck infection

76
Q

Serious/ Life-threatening Consequences of Retropharyngeal Abscess

A

Asphyxia

Spread of infection

77
Q

Etiology of Retropharyngeal Abscess in Children

A

Usually from a lymph node that drains the H&N

78
Q

Etiology of Retropharyngeal Abscess in Adults

A

Penetrating trauma
Infection in the mouth/teeth
Lymph nodes that drain the H&N

79
Q

Signs & Symptoms of Retropharyngeal Abscess

A 
Fever
Dysphagia
Neck pain
Decrease cervical ROM
Cervical lymphadenopathy
Sore throat
Poor oral intake
Muffled voice
Respiratory distress
Stridor (children)
Inflammatory torticollis
80
Q

Workup of Retropharyngeal Abscess

A

Lateral soft tissue X-ray of neck

CT scan

81
Q

Treatment of Retropharyngeal Abscess

A

Immediate ENT consult
I&D
IV hydration
IV antibiotics

82
Q

IV Antibiotics in Retropharyngeal Abscess

A

Clindamycin

Ampicillin-sulbactam (Unasyn)

83
Q

Retropharyngeal Abscess Complications

A

Extension of infection into mediastinum
Pleural/pericardial effusion
Upper airway asphyxia
Sudden rupture

84
Q

Define Ludwig’s Angina

A

Infection of the submandibular space

Progressive cellulitis of soft tissues of neck & floor of mouth

85
Q

Etiology of Ludwig’s Angina

A

Odontogenic
Staph
Strep
Bacteroides

86
Q

Signs & Symptoms of Ludwig’s Angina

A 
Dental pain
Recent hx of dental procedures
Neck swelling
Neck pain
Change in voice
Dysphagia
Glossitis
Dyspnea
Tacypnea
Stridor
87
Q

Physical Exam Findings of Ludwig’s Angina

A

Bilateral submandibular swelling

Protruding tongue

88
Q

Diagnostics of Ludwig’s Angina

A

Clinical

CT

89
Q

Treatment of Ludwig’s Angina

A

Intubation
I&D
Broad spectrum antibiotics

90
Q

Time Frame for a Laryngeal FB Removal

A

ASAP

91
Q

Time Frame for a Bronchial FB Removal

A

Same day as diagnosis

92
Q

Time Frame for an Esophageal FB Removal

A

Variable

93
Q

What is the Cause of Pott’s Puffy Tumor?

A

Complication of frontal sinusitis

Trauma

94
Q

What can Pott’s Puffy Tumor lead to?

A

Intracranial abscess

Venous sinus thrombosis

95
Q

Workup of Pott’s Puffy Tumor?

A

CT

96
Q

Treatment of Pott’s Puffy Tumor

A

Referrel to ENT
Drainage
Debridement
IV antibiotics

97
Q

Etiologies of 7th Nerve Palsy (Bell’s Palsy)

A

Idiopathic
Lyme Disease
HSV
Herpes zoster

98
Q

What do you need to rule out with 7th nerve palsy (Bell’s Palsy)?

A

Tumor

99
Q

Treatment for Bell’s Palsy

A

Steroids

+/- acyclovir

100
Q

Common Bugs for Facial Cellulitis

A

Strep

Staph

101
Q

Treatment for Facial Cellulitis

A

Antibiotics

102
Q

What Does Facial Cellulitis Involve?

A

Deeper dermis & subcutaneous fat

103
Q

What Does Erysipelas Involve?

A

Upper dermis & superficial lymphatics

104
Q

Are Erysipelas Lesions Raised?

A

Yes

105
Q

Treatment for Erysipelas

A

IV antibiotics for Strep & Staph

106
Q

Complication of infections in the “triangle” of the face

A

Septic cavernous thrombosis

ENT (10 decks)

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