ENT emergencies Flashcards
What is important to ascertain from the history in nasal trauma?
Mechanism of injury - fight, sports, falls When LOC Epistaxis Breathing
What should be examined in nasal trauma?
Bruising Swelling Tenderness Deviation Epistaxis Infraorbital sensation Cranial nerves
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
How is a nasal fracture diagnosed?
Clinical - based on deviation
Review in ENT clinic 5-7 days post-injury
What are complications of a nasal fracture?
Epistaxis - esp the anterior ethmoidal artery
CSF leak; can lead to meningitis
Anosmia - cribriform plate fracture
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
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)
What is the management of epistaxis?
Local treatment External pressure to nose Ice Cautery Nasal packing
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&S Arterial ligation
How long does it take a CSF to settle usually?
10 days
A fracture to where can lead to a CSF leak?
Cribriform plate
What are ear emergencies?
Pinna haematoma
Ear laceration
Temporal bone fracture
Sudden sensorineural hearing loss
What can a pinna haematoma lead to?
Subperichondrial haematoma leading to “cauliflower ear” due to calcium deposition
How is a pinna haematoma treated?``
Aspirate haematoma
Incision and drainage
Pressure dressing
What commonly causes lacerations to the ear?
Blunt trauma
Avulsion
dog bites
Tissue loss
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
