ENT Emergencies Flashcards
What should be covered in the history of a patient with ear trauma?
Mechanism of injury (fight, sports, fall), when it happened, loss of consciousness, epistaxis, breathing
What features are you looking for on an examination of nasal trauma?
Bruising, swelling, deviation, epistaxis, CNs, infraorbital sensation
What must be excluded in nasal trauma?
Septal haematoma
How are nasal fractures diagnosed?
Clinical diagnosis, investigations superfluous, based on deviation/cosmesis, breathing important
When should a patient with a nasal fracture be reviewed?
5-7 days post fracture in ENT clinic
When should digital manipulation of a nasal fracture be considered?
In <3 weeks
What are the complications of a nasal fracture?
Epistaxis (particularly anterior ethmoid artery), CSF leak, meningitis, anosmia (cribriform plate fracture)
How common is epistaxis?
5-10% of population experience episode every year = 10% of these see physician (1% of these need specialist)
Why is there so much vasculature in the nose?
Incredible heating/humidification requirement
Where is the vasculature of the nose located?
Just under mucosa (not squamous)
What is the arterial supply to the nose?
Sphenopalatine artery, ethmoid arteries, greater palatine artery
What are some first aid measures for treating epistaxis?
Local treatment, external pressure to nose, ice, cautery, nasal packing
How can the flow of epistaxis be slowed?
Pressure, ice, topical vasoconstrictor +/- LA (lignocaine + adrenaline, co-phenylcaine)
How can a clot from epistaxis be removed?
Suction, nose blow
What are some management options for epistaxis?
Anterior rhinoscopy, cautery/pack, 300 rigid nasendoscopy
How should a patient be managed once the bleeding from the epistaxis has been controlled?
Arrange admission if packed/poor social circumstances, FBC, G and S, don’t sedate them
How should a patient with uncontrolled bleeding from epistaxis be managed?
Consider arterial ligation = sphenopalatine, external carotid, anterior ethmoid
What is the systemic treatment for epistaxis?
Reversal of anticoagulants, correction of clotting abnormalities, platelet transfusion, treatment of hypertension
How are CSF leaks treated?
Usually settle on their own = repair if not settled by 10 days
Where is a common site of fracture that causes CSF leak?
Cribriform plate
What are some ear emergencies?
Pinna haematoma, ear laceration, temporal bone fractures, sudden sensorineural hearing loss
What are some treatment options for pinna haematomas?
Aspiration, incision and drainage, pressure dressing
What are some causes of ear lacerations?
Blunt trauma, avulsion, dog bites, tissue loss
How are ear lacerations managed?
Debridement, closure (primary, reconstruction), usually lignocaine + adrenaline, antibiotics (cartilage)
What should be associates that should be covered in the history of a temporal bone fracture?
Injury mechanism, hearing loss, facial palsy, vertigo, CSF leak, associated injuries
What is examined in a patient with a temporal bone fracture?
Bruising, condition of TM and ear canal, facial nerve, hearing test, look for battle sign bruising behind ear
What are the types of temporal bone fractures?
Longitudinal (80%) or transverse (20%)
Otic capsule involved or spared
What causes longitudinal temporal bone fractures?
Lateral blows = fracture line parallel to long axis of petrous pyramid
What may cause conductive hearing loss associated with a longitudinal temporal bone fracture?
Haemotympanum, ossicular chain disruption
What are some complications of a longitudinal temporal bone fracture?
Bleeding from external canal due to laceration of skin and ear drum, facial palsy (20%)
What causes transverse temporal bone fractures?
Frontal blows = fracture line at right angles to long axis of petrous pyramid
Why can the auditory and facial nerves be damaged by a transverse temporal bone fracture?
Fracture can cross internal acoustic meatus
What are some associated features of transverse temporal bone fractures?
Sensorineural hearing loss due to 8th cranial nerve damage, facial nerve palsy (50%), vertigo
What can cause conductive hearing loss?
Fluid, TM perforation, ossicular problem
Why is conductive hearing loss management usually delayed?
Occurs as part of polytrauma so other injuries are priority = may need facial nerve decompression or manage CSF leak
What are some treatments for conductive hearing loss?
Hearing aid, ossiculoplasty
When are foreign bodies normally removed from the ear?
Can usually wait until urgent clinic for removal
Do watch batteries need to be removed from the ear urgently?
Yes = should be removed immediately
How are live animals removed from the ear?
Drowned in oil and removed the next day
What may cause neck trauma?
Penetrating = knife/GSW/MVA, industrial/household accidents Blunt = MVA, sports injury
Who is neck trauma most common in?
More common in males, especially adolescents/young adults
What neck zone has the highest mortalities associated with trauma to it?
Zone 1
What structures are in zone 1 of the neck?
Trachea, oesophagus, thoracic duct, thyroid, spinal cord, brachiocephalic, subclavian, common carotid, thyrocervical trunk
What structures are in zone 2 of the neck?
Larynx, hypopharynx, CN 10-12, carotids, internal jugular, spinal cord
What structures are in zone 3 of the neck?
Pharynx, cranial nerves, carotids, vertebral vessels, internal jugular vein, spinal cord
What should be covered in the history of neck trauma?
Mechanism of injury
Pain = location, onset, nature, radiation, intensity
What are some symptoms of neck trauma that has damaged the aerodigestive or central nervous systems?
Aerodigestive = Dyspnoea, hoarseness, dysphonia, dysphagia, haemoptysis CNS = weakness, paraesthesia
What should be included in an examination of neck trauma?
ABCDE, stridor, hoarseness, respiratory rate, accessory muscle use, BP, heart rate, palpable pulse
What makes up the secondary survey of neck trauma?
Goes through the platysma, zone of neck affected, bleeding/haematoma, aerodigestive injuries, neurological (power, sensation of upper arm)
What investigations are done for neck trauma?
FBC, G and S, XM, AP/lateral views of neck, CXR (haemo-pneumothorax, emphysema), CT angiogram, MRA
What complications of neck trauma need to be explored urgently?
Expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
What are some interventions done for neck trauma?
Laryngoscopy, bronchoscopy, pharyngoscopy, oesophagoscopy, angiography (embolise, occlude)
What causes a deep space neck infection?
Extension of infection from tonsils or oropharynx into deeper tissues
What are some symptoms of a deep space neck infection?
Sore throat, unwell, limited neck movement, febrile, trismus, red/tender neck
How is deep neck infection treated?
Fluid resuscitation, IV antibiotics, incision and drainage of neck space
Why are maxillary fractures important?
Area acts as bridge between cranial base and dental occlusal plate = functionally and cosmetically important
Are maxillary fractures serious?
Yes = potentially life threatening and disfiguring
What are some symptoms of orbital trauma?
Pain, decreased visual acuity, diplopia, hypoaesthesia in infraorbital region, periorbital ecchymosis, oedema, enophthalmos, restricted ROM
What way a CT scan show in orbital trauma?
Tear drop sign = orbital blowout fracture
What is the management of orbital trauma?
Conservative
Surgical repair of bony walls if entrapment, large defect or significant enophthalmos
What are the types of Le Fort fractures?
Horizontal, pyramidal or transverse
What are important features of the history in a patient with a Le Fort fracture?
Mechanism of injury, airway patency, vision, cranial nerve function
What are some symptoms associated with Le Fort fractures?
Loss of consciousness, confusion, dental occlusion, soft tissue swelling, bruising, haematoma, posterior retrusion of mid-face, upper airway compromise
