ENT Emergencies Flashcards
What trauma most commonly causes nasal fracture?
Fight
Contact sports
Falls
What symptoms must you always remember to ask about in a nasal trauma history?
Loss Of Consciousness
Epistaxis
Breathing difficulty
What should you look for in a nasal fracture examination?
Bruising, Swelling Tenderness Deviation Epistaxis Infraorbital sensation
What should always be considered when there is bruising over the infraorbital area?
Potential damage to the infraorbital nerve
What is the consequence of a septal haematoma?
Necrosis of cartilage due to haematoma pulling perichondrium away and depriving cartilage of blood supply
An X-ray is always required in nasal fracture. TRUE/FALSE?
FALSE
Diagnosis is based on inspection and palpation
What are the complications of a nasal fracture?
Epistaxis – anterior ethmoid artery
CSF leak - can predispose to meningitis
Anosmia – cribriform plate fracture
What is the main blood supply to the lateral nasal wall and septum?
Sphenopalatine artery
What first aid measures can be used for epistaxis?
External Pressure to Nose and sit forward
Ice
Cautery
Nasal Packing
What topical vasoconstrictor can be used for nosebleeds?
Adrenaline on a cotton bud and inserted into nose
What is the aim of a rhino pack in epistaxis?
Compresses sphenopalatine artery and kiesselbach’s area
Why should sedation not be considered as treatment in nosebleed?
Would allow aspiration of blood
What systemic management should be considered after epistaxis?
- Reversal of effect of anticoagulants
- Correction of clotting abnormalities
- Platelet transfusion
- Treatment of hypertension
What complication can result from a haematoma on the pinna of the ear?
“Cauliflower ears”
Necrosis of cartilage due to haematoma moving perichondrium away from cartilage
How are pinna haematomas treated?
Aspirate
Incision and drainage
Pressure dressing
No contact sport for short period of time
How are lacerations of the ear treated?
Debridement to prevent chondritis
Closure and stitch in anatomical postition
What other symptoms should be investigated if there is a suspected temporal bone fracture?
Hearing loss
Facial palsy
Vertigo
CSF leak
What are the two types of temporal bone fracture
Longitudinal (more common)
Transverse (otic capsule involved)
What sign can be visible behind the ear after a temporal bone fracture?
Battles sign
What can a temporal fracture cause to happen to the incus and malleus?
Pulled away from each other
Induces a conductive hearing loss
Temporal fracture treatment is often delayed. TRUE/FALSE?
TRUE
due to polytrauma
What is the rule of 3s with regards to sudden sensorineural hearing loss?
Occurs within 3 days
Drops 30dB at 3 frequencies
What test is used to determine whether or not a patient has had a sensorineural hearing loss?
Webers test (tuning fork)
How is a sudden sensorineural hearing loss treated?
Steroids and urgent ENT referral
intratympanic steroids can also be given
What foreign bodies should be removed immediately?
Batteries!
How are live insects removed?
Oil is placed into ear to kill insect and then dead insect can be removed
What structures are in Zone 1 for neck injuries?
Trachea Oesophagus Thoracic duct Thyroid Large Vessels – brachiocephalic, subclavian, common carotid Spinal cord
What structures are in Zone 2 for neck injuries?
Larynx Hypoharynx CN 10,11,12 Vessels – carotids, internal jugular Spinal Cord
What structures are found in Neck injury zone 3?
Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord
When would a neck injury not be considered penetrating?
If the platysma is still intact
What usually causes a deep neck space infection?
Extension of infection from tonsil or oropharynx into deeper tissues
What features of the history would make you suspect a deep neck space infection?
sore throat, unwell, limited neck movement (move torso instead
How are deep neck space infections treated?
Fluid resuscitation
Intravenous antibiotics
Incision and Drainage of neck space
Where in the neck is known as the danger zone of infection?
Retropharyngeal space (infection can track down to mediastinum)
