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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
Q

what causes a longitudinal facture

A

lateral blows

26
Q

what makes a temporal bone fracture lateral

A

the fracture line parallels the long axis of the petrous pyramid

27
Q

signs of a longitudinal fracture

A

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
Q

what % of temporal bone fractures are transverse

A

20%

29
Q

what causes a transverse temporal bone fracture

A

frontal blow

30
Q

what makes a temporal bone fracture transverse

A

fracture at right angles to the long axis of the petrous pyramid

31
Q

what type of hearing loss is caused by by a transverse fracture

A

sensorineural hearing loss due to a damaged 8th cranial nerve

32
Q

signs of a transverse fracture

A

facial nerve palsy (50%)
vertigo
sensorineural hearing loss

33
Q

causes of conductive hearing loss

A

fluid problems
TM perforation
Ossicular problems

34
Q

how do you manage conductive hearing loss after trauma

A

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
Q

what to do in someone with sudden sensorineural hearing loss

A 
weber test (quick screening test for hearing loss) 
steroids
36
Q

what is the only foreign body which needs removed immediately

A

watch batteries

37
Q

how to treat live animals in ear

A

drown animal with oil then remove the animal at the urgent clinic

38
Q

causes of neck trauma

A

penetrating injuries
industrial accidents
household accidents

blunt trauma - road traffic accidents, sports injuries

39
Q

what is in zone 1 of the neck (trauma)

A 
trachea 
oesophagus 
right thoracic duct 
thyroid 
vessels (brachiocephalic, subclavian, common carotid, thyrocervical trunk) 
spinal cord
40
Q

what is in zone 2 of the neck trauma classifications

A 
larynx 
hypopharynx 
CN 10, 11, 12
Vessels - carotids, internal jugular 
spinal cord
41
Q

what is in zone 3 of the neck trauma classifications

A

pharynx
cranial nerves
vessels - carotids, internal jugular, vertebral
spinal cord

42
Q

questions to ask in the history for neck trauma

A

mechanism of injury
pain - location, nature, intensity, onset, radiation
airway and digestive tract problems
CNS problems - parasthesias, weakness

43
Q

examination for neck trauma

A 
A- airway (stridor, hoarseness) 
B- breathing (RR, accessory muscles) 
C- circulation (BP, HR, palpable) 
D- disability 
E- full exposure
44
Q

Management of neck trauma

A

urgent exploration - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract

laryngoscopy, bronchoscopy, pharyngoscopy and oesphagoscopy

angiography

45
Q

what is a deep neck space infection

A

extension of infection from tonsil or oropharynx into deeper tissues

46
Q

signs of deep neck space infection

A

febrile
trismus (lock jaw)
red/tender neck

47
Q

management of deep space neck infection

A

fluid resuscitation
intravenous antibiotics
incision and drainage of neck space

48
Q

types of trauma to the orbit

A

orbital floor fracture (second most common mid facial fracture)

impact injury to the globe

infraorbital groove is a weak point

49
Q

signs of orbital trauma

A 
periorbital bruising 
oedema 
enopthalmos 
restriction of ocular movement
bony step of orbital rim
50
Q

investigations for orbital trauma

A

CT sinuses
‘tear drop’ sign
blow out fracture - medial wall and floor

51
Q

Management for orbital trauma

A 
conservative 
surgical repair of bony walls if: 
entrapment 
large defect 
significant enophthlamos
52
Q

what surgery is done for le fort fractures

A

reduce fracture and fix

2 ENT (15 decks)

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