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2 ENT > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

1
Q

questions to ask when taking a nasal trauma history

A 
mechanism of injury 
when 
loss of consciousness?
epistaxis 
breathing
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2
Q

Signs of nasal trauma

A 
bruising 
swelling 
tenderness
deviation 
epitaxis 
infraorbital sensation 
cranial nerve palsies
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3
Q

what is a nasal septum haematoma

A

a collection of blood within the septum (under the lining in between the nostrils)

if untreated can cause the septum to collapse

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4
Q

how do you diagnose a nasal fracture

A

clinically - based on clinical examination (investigations not needed)

deviation/cosmesis
breathing

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5
Q

when after injury should a nasal fracture be reviewed in ENT

A

5-7 days post injury

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6
Q

when can you consider digital manipulation in nasal fractures

A

<3 weeks post injury

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7
Q

what are some complications of nasal fractures

A

epistaxis (particularly the anterior ethmoid artery)

CSF leak

meningitis

anosmia - due to cribriform plate fracture

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8
Q

what arteries commonly cause epistaxis

A

sphenopalatine artery
ethmoid arteries
greater palatine artery

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9
Q

first aid management of epistaxis

A

first aid measures:

pressure to nose
ice
cautery (burning of vessels)
nasal packing

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10
Q

management of severe epistaxis

A

resuscitate on arrival if necessary

pressure, ice, topical vasoconstrictor +/- lignocare +adrenaline

remove clot via suction/nose blowing

cautery/nasal pack

cauterise vessel - silver nitrate/diamthermy

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11
Q

management of epistaxis once the bleeding is controlled

A

arrange admission if packed/ poor social circumstances

FBC, G&S

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12
Q

further management of epistaxis if the bleeding is not controlled

A

arterial ligation (tying of the end of an artery)

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13
Q

what are some systemic treatments done for epistaxis

A

reversal of anticoagulants
correction of clotting abnormalities
platelet transfusion
treatment of hypertension

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14
Q

how long does a CSF leak take to settle

A

usually spontaneously wishing 10 days - if not needs repair

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15
Q

what is a common fracture site causing CSF leaks

A

cribriform plate

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16
Q

what are 4 ear emergencies

A

Pinna haematoma
ear lacerations
temporal bone fractures
sudden sensorineural hearing loss

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17
Q

layman term for pinna haematoma

A

cauliflower ear

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18
Q

how do you treat a pinna haematoma

A

aspirate
incision and drainage
pressure dressing

no good evidence for which is the best

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19
Q

causes of ear lacerations

A

blunt trauma
avulsion
dog bits
tissue loss

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20
Q

management of ear lacerations

A

debridement
closure - primary/reconstruction
usually lignocaine + adrenaline
antibiotics

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21
Q

things to ask in history of a temporal bone fracture

A 
injury mechanisms 
hearing loss 
facial palsy 
vertigo 
CSF leak 
associated injuries
22
Q

signs of a temporal bone fracture

A

bruising - battle sign
conditions of TM and ear canal
facial nerve VII (CNVII)
Hearing test

23
Q

what are the types of temporal bone fracture

A

longtidutinal
transverse
otic capsule involved
otic capsule spared

24
Q

what is the most common temporal bone fracture

A

longitudinal fracture (80%)

25
what causes a longitudinal facture
lateral blows
26
what makes a temporal bone fracture lateral
the fracture line parallels the long axis of the petrous pyramid
27
signs of a longitudinal fracture
bleeding from external canal due to laceration of skin and eardrum haemotympanum (conductive hearing loss) ossicular chain disruption facial palsy (20%) CSF otorrhoea (out of the ear)
28
what % of temporal bone fractures are transverse
20%
29
what causes a transverse temporal bone fracture
frontal blow
30
what makes a temporal bone fracture transverse
fracture at right angles to the long axis of the petrous pyramid
31
what type of hearing loss is caused by by a transverse fracture
sensorineural hearing loss due to a damaged 8th cranial nerve
32
signs of a transverse fracture
facial nerve palsy (50%) vertigo sensorineural hearing loss
33
causes of conductive hearing loss
fluid problems TM perforation Ossicular problems
34
how do you manage conductive hearing loss after trauma
often delayed as poly trauma may need facial nerve decompression may need to manage CSF leak - most settle but some need repair may need hearing restoration either hearing aid or ossiculoplasty
35
what to do in someone with sudden sensorineural hearing loss
``` weber test (quick screening test for hearing loss) steroids ```
36
what is the only foreign body which needs removed immediately
watch batteries
37
how to treat live animals in ear
drown animal with oil then remove the animal at the urgent clinic
38
causes of neck trauma
penetrating injuries industrial accidents household accidents blunt trauma - road traffic accidents, sports injuries
39
what is in zone 1 of the neck (trauma)
``` trachea oesophagus right thoracic duct thyroid vessels (brachiocephalic, subclavian, common carotid, thyrocervical trunk) spinal cord ```
40
what is in zone 2 of the neck trauma classifications
``` larynx hypopharynx CN 10, 11, 12 Vessels - carotids, internal jugular spinal cord ```
41
what is in zone 3 of the neck trauma classifications
pharynx cranial nerves vessels - carotids, internal jugular, vertebral spinal cord
42
questions to ask in the history for neck trauma
mechanism of injury pain - location, nature, intensity, onset, radiation airway and digestive tract problems CNS problems - parasthesias, weakness
43
examination for neck trauma
``` A- airway (stridor, hoarseness) B- breathing (RR, accessory muscles) C- circulation (BP, HR, palpable) D- disability E- full exposure ```
44
Management of neck trauma
urgent exploration - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract laryngoscopy, bronchoscopy, pharyngoscopy and oesphagoscopy angiography
45
what is a deep neck space infection
extension of infection from tonsil or oropharynx into deeper tissues
46
signs of deep neck space infection
febrile trismus (lock jaw) red/tender neck
47
management of deep space neck infection
fluid resuscitation intravenous antibiotics incision and drainage of neck space
48
types of trauma to the orbit
orbital floor fracture (second most common mid facial fracture) impact injury to the globe infraorbital groove is a weak point
49
signs of orbital trauma
``` periorbital bruising oedema enopthalmos restriction of ocular movement bony step of orbital rim ```
50
investigations for orbital trauma
CT sinuses 'tear drop' sign blow out fracture - medial wall and floor
51
Management for orbital trauma
``` conservative surgical repair of bony walls if: entrapment large defect significant enophthlamos ```
52
what surgery is done for le fort fractures
reduce fracture and fix

2 ENT (15 decks)

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