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ENT > ENT emergencies > Flashcards

ENT emergencies Flashcards

1
Q

what is epistaxis

A

noose bleed

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2
Q

where do you asses sensation in a nasal trauma

A

infraorbital- where infraorbital nerve runs

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3
Q

what motor nerves do you sens in a nasal trauma

A

CN 3,4 and 6

eye movements

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4
Q

what must you exclude in a nasal trauma

A

a septal haematoma

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5
Q

what is the relevance of a septal haematoma

A

can cut off the blood supply to cartilage- necrosis- can also lead to infection
needs to be evacuated

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6
Q

what is the blood supply to the nasal cartilage

A

perichondrium

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7
Q

what is the treatment for a nasal fracture

A

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

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8
Q

what are the complications of a nasal fracture

A

epitaxis- especially anterior ethmoid artery
CSF leak- created risk of meningitis
anosmia- cribiform plate fracture (injury CN 1)

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9
Q

why do you get recurrent epitaxis after a nasal fracture

A

as artery will go into spam and then stop every few days

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10
Q

what is the main blood supply to the nose

A

sphenopalatine, poster and anterior ethmoid arteries

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11
Q

what is the anastamosis of the nasal arteries called

A

Kiesselbach’s area- common site for epitaxis to occur

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12
Q

how do you manage epitaxis

A

external pressure to the nose, sit forward
ice
cautery
nasal packing
if doesnt stop within 20 mins then go to hospital

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13
Q

how do you manage a severe epitaxis

A 
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

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14
Q

what is the management for a CSF leak after a nasal fracture

A

usually settles within 10 days

if not needs repair

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15
Q

what is the risk of a CSF leak

A

ascending infection- meningitis

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16
Q

where might the fracture be when there is a CSF leak

A

cribiform plate

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17
Q

what are 4 ear emergencies

A

pinna haematoma
ear lacerations
temporal bone fractures
sudden SN hearing loss

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18
Q

what is a pinna haematoma

A

sub perichondral haematoma

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19
Q

what is the treatment for a pinna haematoma

A 
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
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20
Q

what is the management for a ear laceration

A 
debridement 
closure (primary) 
reconstruction 
usually LA 
antibiotics (to prevent chondritis)
21
Q

what must you ask about in a temporal fracture

A 
injury mechanism 
hearing loss
facial palsy 
vertigo 
CSF leak (coming out of the ear) 
associated injuries
22
Q

what is a battle sign

A

bruising behind the ear, suggest a base of skull fracture

23
Q

how do you test the facial nerve

A

do facial movements

24
Q

what are the types of temporal fractures

A

longitudinal vs transverse

otic capsule sparing vs involving

25
Q

what are the features and common complications of a longitudinal temporal fracture

A

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

26
Q

what are the features and complications of a transverse temporal fracture

A 
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

27
Q

what can cause conductive hearing loss

A

fluid
TM perforation
ossicular problem (dislocation)

28
Q

what is the management for a conductive hearing loss

A

depends on cause

may need hearing ad or ossiculoplasty (to realign the ossicles)

29
Q

what is the management for a sudden (<3 days) senorineural hearing loss (at least 30 dB at 3 frequencies)

A

weber test to make sure it sensorineural

give steroids asap

30
Q

what can cause sudden sensorineural hearing loss

A

immune mediated, idiopathic, viruses

31
Q

what is the rinne test

A

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)

32
Q

what is quiter/ louder in SN and conductive HL

A

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)

33
Q

what is the webers test

A

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)

34
Q

what foreign body do you always remove immediately

A

batteries

35
Q

what is zone 1 for knife neck injuries

A

included trachea, oesophagus, thoracic duct, thyroid, vessels (brachiocephalic, subclavian, common carotid, thyrocervical, spinal cord

36
Q

what is zone 2 for knife neck injuries

A

larynx, hypopharynx, CN 10, 11 and 12, vessels (carotids, internal jugular), spinal cord

37
Q

what is zone 3 for knife neck injuries

A

pharynx, cranial nerves, vessels (carotids, IJV, vertebral), spinal cords

38
Q

what aerodigestive features should you look out for in a knife neck injury

A

dsypnoea, hoarseness, dysphonia, dysphagia, haemoptysis

39
Q

when is a neck injury penetrating

A

if it goes through the platysma

if doesn’t go beneath this then can close in a and e

40
Q

why do you do a chest x ray in a knife neck wound

A

haemopneumothorax, emphysema

41
Q

what needs urgent exploration in a knife neck injury

A

expanding haematoma, hypovolaemic shocl, airway obstruction, blood in aerodigestive tract

42
Q

what allows the spread of a deep neck space infection

A

extends from tonsils or oropharynx

common in parapharyngeal (infection from tonsils) space which can spread downwards the retropharyngeal space

43
Q

what are the features of a deep neck space infection

A

sore throat, unwell, limited neck movement

febrile, trismus, red/tender neck

44
Q

what is the management for a deep space neck infection

A

fluid resus, IV antibiotics, incision and drainage of neck space

45
Q

what can happen if a swallowed foreign body is delayed in its removal

A

swelling and oedema, making it a lot harder to remove

46
Q

what is the weak point of the orbit

A

infraorbital groove

47
Q

what are the common features of an orbit fracture

A 
pain, decreased visual acuity, diplopia 
hypoaesthesia in infraorbital region 
periorbital ecchymosis (skin discolouration) 
oedema 
enopthalmos 
restriction of ocular movement 
tear drop sign on CT
48
Q

what is the management of orbital fractures

A 
conservative 
surgical repair if:
-entrapment 
-large defect 
-significant enopthlamos
49
Q

what are the types of le fort fractures

A
  1. horizontal (above teeth apices)
  2. pyramidal
  3. transverse (craniofacial dysjunctions)

ENT (27 decks)

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