ENT Emergencies Flashcards
What must be excluded in nasal fractures?
septal haematomas - in the perichondrium
How are nasal fractures treated?
digital manipulation up to 3 weeks after the event
What are the possible complications of nasal fractures?
CSF leak - can lead to meningitis
epistaxis - heavy then stops due to artery spasming (anterior ethmoid artery)
anosmia - due to cribiform plate fracture
Why is epitaxis so common in the nose?
no squamous epithelium over the vasculature to protect it
How is epitaxis managed?
topical vasoconstrictor local anaesthetic ice pressure anterior rhinoscopy 30 degree rigic nasendoscopy cauterise vessel by silver nitrate/diathermy rapid rhino packs remove clot through suction
What is the managment if an epitaxis cannot be controlled?
consider arterial ligation
When does a CSF leak need repair?
after 10 days
How is a pinna haematoma managed?
pressure dressings and drainage
When would you give antibiotics to a laceration on the ear?
if it affects the cartilage
What are the two types of temporal bone fractures?
longitudinal - most common
transverse
Describe longitudinal temporal bone fractures?
otic capsule involved
usually from lateral blows
can cause conductive hearing loss through haemotympanum or ossicular chain disruption
20% result in facial palsy
fracture line is parallel to the long axis of the petrous pyramid
Describe transverse temporal bone fractures?
otic capsule not involved
frontal or behind blows
can cause sensorineural hearing loss due to CN VIII damage
50% result in facial palsy and vertigo
fracture line is at right angles to the long axis of the petrous pyramid
can cross the IAM which damages the nerves
What are the signs/investigations of a temporal bone fracture?
battle sign
hearing tests
look at the TM and ear canal
What is the management of a temporal bone fracture?
hearing aids
facial nerve decompression
What is sensorineural hearing loss treated with?
predisolone 60mg
When should forgein bodies be removed?
if they are round batteries - can burn through the skin
What is Zone 1 in neck trauma?
trachea oesophagus thoracic duct thyroid brachiocephalic subclavian common carotid thyrocervical trunk spinal cord
What is Zone 2 in neck trauma?
larynx hypopharynx CN 10, 11, 12 carotids internal jugular spinal cord
What is Zone 3 in neck trauma?
pharynx cranial nerves carotids internal jugular vein vertebrae spinal cord
What is the most common neck zone to reveive trauma?
zone 1
What are the investigations done for neck trauma?
FBC, G&S, XM AP/Lateral neck Xray CXR for haemopneumothorax and empysema CT angiogram - pseudoaneurysm MRA - magnetic resonance angiography
How does a deep neck space infection present?
extension of infection from tonsil or oropharynx into deeper tissue
sore throat
unwell
limited neck movement
What are the signs of deep neck space infections?
febrile
trismus - reduces jaw opening
red/tender neck
What is the management of deep neck space infections?
fluid resuscitation
IV antibiotics
incision and drainage
What are the signs of an orbital fracture?
pain diplopia decreased visual acuity periorbital echymosis hypoaesthesia in the infraorbital region oedema enopthalmos restriction of ocular movement bony step of orbital rim
What sign is seen on a CT scan of an orbital fracture?
teardrop sign
When would an orbital fracture be surgically repaired?
entrapment
large defect
significant enopthalmus
