ENT emergencies Flashcards
what information is required in the history of someone with nasal trauma?
History -Mechanism of injury -Fight, sport, falls When LOC Epistaxis Breathing
what is seen in the examination of someone with nasal trauma?
Bruising, Swelling Tenderness Deviation Epistaxis Infraorbital sensation CNs
what is important to exclude when handling nasal traumas always?
septal haematoma
how can nasal fractures be diagnosed?
clinically without investigations as they are unnecessary
based on deviation/cosmesis and breathing
when should you review someone with a nasal fracture in ENT clinic?
5-7 days post-injury
when should you consider digital manipulation in someone with a nasal fracture?
< 3 weeks
what are the complications of nasal fractures?
Epistaxis – particularly ant ethmoid artery
CSF leak , meningitis
Anosmia – cribriform plate fracture
what percent of the population will experience an episode of epistaxis each year?
5-10% of the population experience an episode of epistaxis each year. 10% of those will see a physician. 1% of those seeking medical care will need a specialist.
why is the nose prone to epistaxis?
Vascular organ secondary to incredible heating/humidification requirements
Vasculature runs just under mucosa (not squamous)
Arterial to venous anastamoses
ICA and ECA blood flow
what blood vessels cause epistaxis?
sphenopalatine artery, ethmoid arteries, greater palatine artery
what is the first aid measures when dealing with epistaxis?
Local Treatment External Pressure to Nose Ice Cautery Nasal Packing
what is the further management of epistaxis?
Resuscitate on arrival if necessary
Arrest/slow flow: pressure, ice, topical vasoconstrictor +/- LA (Lignocaine + adrenaline, Co-phenylcaine)
Remove clot: suction, nose blowing
Anterior Rhinoscopy
Cautery / pack
300 rigid nasendoscopy
Cauterise vessel: silver nitrate / diathermy
if the bleeding in epistaxis is controlled?
Arrange admission if packed/poor social circumstances
FBC, G&S
Please don’t consider sedation
what if the bleeding isn’t controlled in epistaxis?
Consider arterial ligation (SPA, Ant ethmoid, external carotid)
what is the systemic treatment of epistaxis?
Reversal of effect of anticoagulants
Correction of clotting abnormalities
Platelet transfusion
Treatment of hypertension
what is a CSF leak?
A CSF leak is a condition that occurs when the CSF leaks through a defect in the dura or the skull and out through the nose or ear.
A CSF leak results from a hole or tear in the dura, the outermost layer of the meninges. Causes of the hole or tear can include head injury and brain or sinus surgery. CSF leaks may also occur after lumbar puncture, also called a spinal tap or spinal anesthesia. Spontaneous CSF leaks can also occur for no known reason.
how to manage CSF leaks?
often settles spontaneously - need repair if not within 10 days
what could be a site of fracture for CSF leaks?
cribriform plate
what is the roe of antibiotics in treatment of a CSF leak?
not clear - ascending infection
what are ear emergencies?
Pinna Haematoma
Ear Lacerations
Temporal bone fractures
Sudden sensorineural hearing loss
what is a pinna haematoma?
it is a sub-perichondria hematoma.
Shearing forces to the auricle can lead to separation of the anterior auricular perichondrium from the underlying, tightly adherent cartilage. As a result, there can be tearing of the perichondrial blood vessels and subsequently a hematoma formation.
treatment of a pinna hematoma?
Aspirate
Incision and drainage
Pressure dressing
No good evidence which technique is best.
what can cause ear lacerations?
Blunt trauma
Avulsion
Dog bites
Tissue loss
what is the management of ear lacerations?
Debridement Closure Primary Reconstruction Usually LA Antibiotics - cartilage
what to ask for in the history of someone with temporal bone fractures?
Injury mechanism Hearing loss Facial palsy Vertigo CSF leak Associated injuries
what do you see in the examination of someone with a temporal bone fracture?
Bruising – Battle sign
Condition of TM and ear canal
VII
Hearing test
