ENT emergencies Flashcards
what is epistaxis
noose bleed
where do you asses sensation in a nasal trauma
infraorbital- where infraorbital nerve runs
what motor nerves do you sens in a nasal trauma
CN 3,4 and 6
eye movements
what must you exclude in a nasal trauma
a septal haematoma
what is the relevance of a septal haematoma
can cut off the blood supply to cartilage- necrosis- can also lead to infection
needs to be evacuated
what is the blood supply to the nasal cartilage
perichondrium
what is the treatment for a nasal fracture
based on deviation, breathing, cosmesis
evacuate any septal haematoma
review in ENT clinic 5-7 days post injury
consider digital manipulation <3 weeks, after this bones fixed
what are the complications of a nasal fracture
epitaxis- especially anterior ethmoid artery
CSF leak- created risk of meningitis
anosmia- cribiform plate fracture (injury CN 1)
why do you get recurrent epitaxis after a nasal fracture
as artery will go into spam and then stop every few days
what is the main blood supply to the nose
sphenopalatine, poster and anterior ethmoid arteries
what is the anastamosis of the nasal arteries called
Kiesselbach’s area- common site for epitaxis to occur
how do you manage epitaxis
external pressure to the nose, sit forward
ice
cautery
nasal packing
if doesnt stop within 20 mins then go to hospital
how do you manage a severe epitaxis
resus if necessary stop flow- pressure, ice, topical vasoconstrictor remove clot- suction, nose blowing anterior rhinoplasty cautery/pack arterial ligation
never sedate- can aspirate on the blood
reversal of anticoagulants
correction of clotting abnormalities
platelet transfusion
hypertension Tx
what is the management for a CSF leak after a nasal fracture
usually settles within 10 days
if not needs repair
what is the risk of a CSF leak
ascending infection- meningitis
where might the fracture be when there is a CSF leak
cribiform plate
what are 4 ear emergencies
pinna haematoma
ear lacerations
temporal bone fractures
sudden SN hearing loss
what is a pinna haematoma
sub perichondral haematoma
what is the treatment for a pinna haematoma
need to be evacuated as cartilage can die- causes cauliflower ears = aspirate incision and drainage pressure dressing (stays on for a week) avoid contact sports for a few weeks
what is the management for a ear laceration
debridement closure (primary) reconstruction usually LA antibiotics (to prevent chondritis)
what must you ask about in a temporal fracture
injury mechanism hearing loss facial palsy vertigo CSF leak (coming out of the ear) associated injuries
what is a battle sign
bruising behind the ear, suggest a base of skull fracture
how do you test the facial nerve
do facial movements
what are the types of temporal fractures
longitudinal vs transverse
otic capsule sparing vs involving
what are the features and common complications of a longitudinal temporal fracture
most common type of temporal #
caused by lateral blows
fracture line parallels the long axis of the petrous pyramid
bleeding from the external canal due to laceration of skin an ear drum
haemotympanum (conductive HL)
ossicular chain disruption (Conductive HL)
facial palsy 20%
CSF otorrhoea
usually spare the otic capsule
what are the features and complications of a transverse temporal fracture
20% caused by frontal blows can cross IAM damaging auditory and facial nerves SN HL due to damage of 8th CN facial nerve palsy 50% vertigo
less common temporal fracture but more likely to get hearing loss and facial paralysis
what can cause conductive hearing loss
fluid
TM perforation
ossicular problem (dislocation)
what is the management for a conductive hearing loss
depends on cause
may need hearing ad or ossiculoplasty (to realign the ossicles)
what is the management for a sudden (<3 days) senorineural hearing loss (at least 30 dB at 3 frequencies)
weber test to make sure it sensorineural
give steroids asap
what can cause sudden sensorineural hearing loss
immune mediated, idiopathic, viruses
what is the rinne test
tuning fork on mastoid process and then beside ear. if patient says its louder going through air then positive rinne test (air conduction is intact, SN HL or normal).
if patient says it is louder through bone then negative result and is a conductive hearing loss (air conduction affected)
what is quiter/ louder in SN and conductive HL
SN sounds will be percieved to be quieter on affected side
in conductive sounds on affected sides seems louder (up regulation, trapping of sound waves)
what is the webers test
compares bone conduction
tuning fork medially on patients head
should be heard equally on both sides
if sound louder on one side= lateralisation (SN HL lateralises to the UNAFFECTED SIDE- louder in healthy ear) (CHL sound lateralises to the AFFECTED SIDE- will be louder in abnormal ear)
what foreign body do you always remove immediately
batteries
what is zone 1 for knife neck injuries
included trachea, oesophagus, thoracic duct, thyroid, vessels (brachiocephalic, subclavian, common carotid, thyrocervical, spinal cord
what is zone 2 for knife neck injuries
larynx, hypopharynx, CN 10, 11 and 12, vessels (carotids, internal jugular), spinal cord
what is zone 3 for knife neck injuries
pharynx, cranial nerves, vessels (carotids, IJV, vertebral), spinal cords
what aerodigestive features should you look out for in a knife neck injury
dsypnoea, hoarseness, dysphonia, dysphagia, haemoptysis
when is a neck injury penetrating
if it goes through the platysma
if doesn’t go beneath this then can close in a and e
why do you do a chest x ray in a knife neck wound
haemopneumothorax, emphysema
what needs urgent exploration in a knife neck injury
expanding haematoma, hypovolaemic shocl, airway obstruction, blood in aerodigestive tract
what allows the spread of a deep neck space infection
extends from tonsils or oropharynx
common in parapharyngeal (infection from tonsils) space which can spread downwards the retropharyngeal space
what are the features of a deep neck space infection
sore throat, unwell, limited neck movement
febrile, trismus, red/tender neck
what is the management for a deep space neck infection
fluid resus, IV antibiotics, incision and drainage of neck space
what can happen if a swallowed foreign body is delayed in its removal
swelling and oedema, making it a lot harder to remove
what is the weak point of the orbit
infraorbital groove
what are the common features of an orbit fracture
pain, decreased visual acuity, diplopia hypoaesthesia in infraorbital region periorbital ecchymosis (skin discolouration) oedema enopthalmos restriction of ocular movement tear drop sign on CT
what is the management of orbital fractures
conservative surgical repair if: -entrapment -large defect -significant enopthlamos
what are the types of le fort fractures
- horizontal (above teeth apices)
- pyramidal
- transverse (craniofacial dysjunctions)
