ENT emergencies Flashcards
What supplies the cartilage?
Perichondrium
What can cause cartilage necrosis?
Bilateral septal heamatoma
When should a nasal bone be manipulated in?
<3 weeks
What are complications of a broken nose?
Epistaxis
CSF leak
Meningitis
Anosmia
What is the management of a nosebleed?
Local treatment External pressure to nose Ice Cautery Nasal packing
How is severe epistaxis managed?
Resusitate on arrival if necessary Arrest/slow flow Remove clot, suction, nose blowing Anterior rhinoscopy Cautery Systemic treatment Reversal of effect of anticoagulants Correction of clotting abnormalities Platelet tranfusion Treatment of hyper tension
When do CSF leaks need repair?
<10 days
What are some ear emergencies?
Pinna Haematoma
Ear lacerations
Temporal bone fratures
Sudden sensorineural hearing loss
What is the treatment of a pinna haematoma?
Aspirate Incision Drainage Pressure dressing No good evidence which technique is best
What can lacerations?
Blunt trauma
Avulsion
Dog bites
Tissue loss
What is the treatment of lacerations to the ear?
Debridement
Closure
Usually Lignocaine and adrenaline
Antibiotics if cartilage?
What are important parts of an ENT history?
Injury mechanism Hearing loss Facial palsy Vertigo CSF leak Associated injuries
What is battles sign?
Bruising around the back of the ear
What is battles sign a sign of?
Base of skull fracture?
What is the classification of skull fractures?
Longitudinal vs transvere
Otic capsule involved or spares
What causes logitudinal fracture?
Lateral blows
What are features of a longitudinal fractures?
Fracture line parallels the long axis of the petrous pyramid
Bleeding from external canal due to the laceration of skin and ear drum
What is Haemotympanum?
Conductive deafness
Transvere fracture
+++
What is the management of skull fractures?
Often delayed as polytrauma Facial nerve decompression EMG stufies Manage CSF lek May need hearing restoration
What is sudden sensorineural hearing loss?
Hearing loss within 3 days of at least 30 decibels
What is the tx of SSHL?
High dose prednisolone for 3 days
What foregin body in the ear is an emergency?
Watch batteries
What is included within zone 1 of the neck?
Trachea Oesophagus Thoracic duct Thyroid Vessels Spinal cord
What is included in zone 2?
Larynx Hypopharync CN 10,11,12 Carotids Internal jugular Spinal cord
What is included in zone 3?
Pharynx
Cranial nerve
Carotids IJV
SPinal cord
What investigations are there for a neck laceration?
FBC G and S XM Ap/Lateral neck CXR - haemo-pneumothrac CT angiogram MRA
What is a deep neck space infection?
Extension of infection from tonsil or oropharynx into deeper tissues
What is a classic history of DNSI?
Sore throat
Unwell
Limited neck movement
WHat is seen on examination of DNSI?
Febrile
Trismus
Red/tender neck
What is the Tx for DSNI?
Fluid resus
IV Ab
Incision and drainage
