ENT emergencies Flashcards by Joanna Mitchell

What is important to ascertain from the history in nasal trauma?

Mechanism of injury - fight, sports, falls
When
LOC
Epistaxis
Breathing

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What should be examined in nasal trauma?

Bruising
Swelling
Tenderness
Deviation 
Epistaxis
Infraorbital sensation 
Cranial nerves

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What needs to be excluded in nasal trauma and why?

Septal haematoma - this indicates that the blood supply to the nasal cartilage is compromised, needs to be excised as can lead to necrosis and a septal abscess

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How is a nasal fracture diagnosed?

Clinical - based on deviation

Review in ENT clinic 5-7 days post-injury

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What are complications of a nasal fracture?

Epistaxis - esp the anterior ethmoidal artery
CSF leak; can lead to meningitis
Anosmia - cribriform plate fracture

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Why can noses bleed so much?

Highly vascular organ secondary to incredible heating/humidification requirements
Vascular runs just under mucosa
Arterial to venous anastomoses
ICA and ECA blood flow

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What arteries make up kisselbach’s area?

Sphenoplatine artery (maxillary artery)
Ant. and post. ethmoidal arteries (ophthalmic artery)
Superior labial artery (facial artery)
Greater palatine artery (maxillary artery)

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What is the management of epistaxis?

Local treatment 
External pressure to nose
Ice
Cautery
Nasal packing

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What management can be performed in hospital for epistaxis?

Arrest flow: pressure, ice, topical vasoconstrictor +/- LA 
Remove clot, sucion, nose blowing
Cautery, pack
30 degrees rigid nasendoscopy
Cauterise vessels 
FBC, G&amp;S
Arterial ligation

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How long does it take a CSF to settle usually?

10 days

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A fracture to where can lead to a CSF leak?

Cribriform plate

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What are ear emergencies?

Pinna haematoma
Ear laceration
Temporal bone fracture
Sudden sensorineural hearing loss

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What can a pinna haematoma lead to?

Subperichondrial haematoma leading to “cauliflower ear” due to calcium deposition

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How is a pinna haematoma treated?``

Aspirate haematoma
Incision and drainage
Pressure dressing

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What commonly causes lacerations to the ear?

Blunt trauma
Avulsion
dog bites
Tissue loss

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How are lacerations to the ear managed?

Debridement
Primary closure or reconstruction
Usually local anaesthetic
Need washout with antibiotics if cartilage is seen

Where is a common site on the temporal bone for a fracture?

Prerion suture

What is the common history of a temporal bone fracture?

Injury mechanism
Hearing loss
Facial palsy
Vertigo
CSF leak

What can be seen on examination of a temporal bone/ basilar skull fracture?

Battles sign
Condition of TM and ear canal
VII - facial movements
Hearing test

How can temporal bone fractures be classified?

Longitudinal vs transverse
Otic capsule involvement
Otic capsule sparing

Describe a longitudinal temporal bone fracture?

Lateral blow
Fracture line parallels the long axis of the petrous pyramid
Bleeding from external canal due to laceration of the skin and ear drum
Hemotympanum (conductive deafness)
Ossicular chain disruption
Facial palsy

Describe a transverse fracture?

Frontal blows
Fracture at right angles to the long axis of the petrous pyramid
Can cross the internal acoustic meatus causing damage to the auditory and facial nerves
Sensorineural hearing loss due to damage of the 8th CN
Facial nerve palsy and vertigo

What needs to be suspected in a conductive hearing loss?

Fluid
TM perforation
Ossicular probelm

How is a temporal bone fracture managed?

Facial nerve decompression
Manage CSF leak
Hearing restoration

How is a sudden sensorineural hearing loss assessed?

Weber test Steroids RULE OF 3s: within 3 days in one ear of at least 30 dbs at 3 different frequencies

What foreign body needs to be removed immediately?

Batteries

What is classified as a zone 1 neck injury?

``` Trachea Oesophagus Thoracic duct Thyroid Vessels - brachiocephalic, subclavian, common carotid, thyrocervical trunk Spinal cord ```

What is classified as a zone 2 neck injury?

``` Larynx Hypopharynx CN 10,11,12 Vessels - carodits, internal jugular Spinal cord ```

What is classified as a zone 3 neck injury?

Pharynx Cranial nerves Vessels - carotids, IJV, vertebral Spinal cord

What needs to be taken in the history of a neck injury?

Mechanism Pain: location, intensity, onset, radiation Aerodigestive tract: dyspnoea, hoarseness, dysphonia, dysphagia, haemoptysis CNS: paraesthesia, weakness

What investigations should be done in a neck injury?

``` FBC, group and save, cross match AP/lateral neck CXR - hemopneumothorax, emphysema CT angiogram - vascular, pseudoaneurysm, laryngeal aerodigestive tract MRA ```

How should a neck injury be managed?

Urgent exploration: expanding haematoma, hypovolaemia shock, airway obstruction, blood in aerodigestive tract Laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy Angiography - eoblize, occlude

What can a deep neck space infection lead to?

From tonsil into deeper tissues | Mediastinal abscess

How should a deep neck infection be managed?

Fluid resuscitation IV antibiotics Incision and drainage of neck space

What needs to be done if you suspect a foreign object has been swallowed?

AP and lateral x-ray views

What will a CT of an orbital blow out fracture look like?

Tear drop sign | Medial wall and floor injuries