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ENT Medicine > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

1
Q

What should be covered in the history of a patient with ear trauma?

A

Mechanism of injury (fight, sports, fall), when it happened, loss of consciousness, epistaxis, breathing

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2
Q

What features are you looking for on an examination of nasal trauma?

A

Bruising, swelling, deviation, epistaxis, CNs, infraorbital sensation

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3
Q

What must be excluded in nasal trauma?

A

Septal haematoma

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4
Q

How are nasal fractures diagnosed?

A

Clinical diagnosis, investigations superfluous, based on deviation/cosmesis, breathing important

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5
Q

When should a patient with a nasal fracture be reviewed?

A

5-7 days post fracture in ENT clinic

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6
Q

When should digital manipulation of a nasal fracture be considered?

A

In <3 weeks

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7
Q

What are the complications of a nasal fracture?

A

Epistaxis (particularly anterior ethmoid artery), CSF leak, meningitis, anosmia (cribriform plate fracture)

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8
Q

How common is epistaxis?

A

5-10% of population experience episode every year = 10% of these see physician (1% of these need specialist)

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9
Q

Why is there so much vasculature in the nose?

A

Incredible heating/humidification requirement

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10
Q

Where is the vasculature of the nose located?

A

Just under mucosa (not squamous)

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11
Q

What is the arterial supply to the nose?

A

Sphenopalatine artery, ethmoid arteries, greater palatine artery

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12
Q

What are some first aid measures for treating epistaxis?

A

Local treatment, external pressure to nose, ice, cautery, nasal packing

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13
Q

How can the flow of epistaxis be slowed?

A

Pressure, ice, topical vasoconstrictor +/- LA (lignocaine + adrenaline, co-phenylcaine)

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14
Q

How can a clot from epistaxis be removed?

A

Suction, nose blow

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15
Q

What are some management options for epistaxis?

A

Anterior rhinoscopy, cautery/pack, 300 rigid nasendoscopy

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16
Q

How should a patient be managed once the bleeding from the epistaxis has been controlled?

A

Arrange admission if packed/poor social circumstances, FBC, G and S, don’t sedate them

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17
Q

How should a patient with uncontrolled bleeding from epistaxis be managed?

A

Consider arterial ligation = sphenopalatine, external carotid, anterior ethmoid

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18
Q

What is the systemic treatment for epistaxis?

A

Reversal of anticoagulants, correction of clotting abnormalities, platelet transfusion, treatment of hypertension

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19
Q

How are CSF leaks treated?

A

Usually settle on their own = repair if not settled by 10 days

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20
Q

Where is a common site of fracture that causes CSF leak?

A

Cribriform plate

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21
Q

What are some ear emergencies?

A

Pinna haematoma, ear laceration, temporal bone fractures, sudden sensorineural hearing loss

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22
Q

What are some treatment options for pinna haematomas?

A

Aspiration, incision and drainage, pressure dressing

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23
Q

What are some causes of ear lacerations?

A

Blunt trauma, avulsion, dog bites, tissue loss

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24
Q

How are ear lacerations managed?

A

Debridement, closure (primary, reconstruction), usually lignocaine + adrenaline, antibiotics (cartilage)

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25
Q

What should be associates that should be covered in the history of a temporal bone fracture?

A

Injury mechanism, hearing loss, facial palsy, vertigo, CSF leak, associated injuries

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26
Q

What is examined in a patient with a temporal bone fracture?

A

Bruising, condition of TM and ear canal, facial nerve, hearing test, look for battle sign bruising behind ear

27
Q

What are the types of temporal bone fractures?

A

Longitudinal (80%) or transverse (20%)

Otic capsule involved or spared

28
Q

What causes longitudinal temporal bone fractures?

A

Lateral blows = fracture line parallel to long axis of petrous pyramid

29
Q

What may cause conductive hearing loss associated with a longitudinal temporal bone fracture?

A

Haemotympanum, ossicular chain disruption

30
Q

What are some complications of a longitudinal temporal bone fracture?

A

Bleeding from external canal due to laceration of skin and ear drum, facial palsy (20%)

31
Q

What causes transverse temporal bone fractures?

A

Frontal blows = fracture line at right angles to long axis of petrous pyramid

32
Q

Why can the auditory and facial nerves be damaged by a transverse temporal bone fracture?

A

Fracture can cross internal acoustic meatus

33
Q

What are some associated features of transverse temporal bone fractures?

A

Sensorineural hearing loss due to 8th cranial nerve damage, facial nerve palsy (50%), vertigo

34
Q

What can cause conductive hearing loss?

A

Fluid, TM perforation, ossicular problem

35
Q

Why is conductive hearing loss management usually delayed?

A

Occurs as part of polytrauma so other injuries are priority = may need facial nerve decompression or manage CSF leak

36
Q

What are some treatments for conductive hearing loss?

A

Hearing aid, ossiculoplasty

37
Q

When are foreign bodies normally removed from the ear?

A

Can usually wait until urgent clinic for removal

38
Q

Do watch batteries need to be removed from the ear urgently?

A

Yes = should be removed immediately

39
Q

How are live animals removed from the ear?

A

Drowned in oil and removed the next day

40
Q

What may cause neck trauma?

A 
Penetrating = knife/GSW/MVA, industrial/household accidents
Blunt = MVA, sports injury
41
Q

Who is neck trauma most common in?

A

More common in males, especially adolescents/young adults

42
Q

What neck zone has the highest mortalities associated with trauma to it?

A

Zone 1

43
Q

What structures are in zone 1 of the neck?

A

Trachea, oesophagus, thoracic duct, thyroid, spinal cord, brachiocephalic, subclavian, common carotid, thyrocervical trunk

44
Q

What structures are in zone 2 of the neck?

A

Larynx, hypopharynx, CN 10-12, carotids, internal jugular, spinal cord

45
Q

What structures are in zone 3 of the neck?

A

Pharynx, cranial nerves, carotids, vertebral vessels, internal jugular vein, spinal cord

46
Q

What should be covered in the history of neck trauma?

A

Mechanism of injury

Pain = location, onset, nature, radiation, intensity

47
Q

What are some symptoms of neck trauma that has damaged the aerodigestive or central nervous systems?

A 
Aerodigestive = Dyspnoea, hoarseness, dysphonia, dysphagia, haemoptysis
CNS = weakness, paraesthesia
48
Q

What should be included in an examination of neck trauma?

A

ABCDE, stridor, hoarseness, respiratory rate, accessory muscle use, BP, heart rate, palpable pulse

49
Q

What makes up the secondary survey of neck trauma?

A

Goes through the platysma, zone of neck affected, bleeding/haematoma, aerodigestive injuries, neurological (power, sensation of upper arm)

50
Q

What investigations are done for neck trauma?

A

FBC, G and S, XM, AP/lateral views of neck, CXR (haemo-pneumothorax, emphysema), CT angiogram, MRA

51
Q

What complications of neck trauma need to be explored urgently?

A

Expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract

52
Q

What are some interventions done for neck trauma?

A

Laryngoscopy, bronchoscopy, pharyngoscopy, oesophagoscopy, angiography (embolise, occlude)

53
Q

What causes a deep space neck infection?

A

Extension of infection from tonsils or oropharynx into deeper tissues

54
Q

What are some symptoms of a deep space neck infection?

A

Sore throat, unwell, limited neck movement, febrile, trismus, red/tender neck

55
Q

How is deep neck infection treated?

A

Fluid resuscitation, IV antibiotics, incision and drainage of neck space

56
Q

Why are maxillary fractures important?

A

Area acts as bridge between cranial base and dental occlusal plate = functionally and cosmetically important

57
Q

Are maxillary fractures serious?

A

Yes = potentially life threatening and disfiguring

58
Q

What are some symptoms of orbital trauma?

A

Pain, decreased visual acuity, diplopia, hypoaesthesia in infraorbital region, periorbital ecchymosis, oedema, enophthalmos, restricted ROM

59
Q

What way a CT scan show in orbital trauma?

A

Tear drop sign = orbital blowout fracture

60
Q

What is the management of orbital trauma?

A

Conservative

Surgical repair of bony walls if entrapment, large defect or significant enophthalmos

61
Q

What are the types of Le Fort fractures?

A

Horizontal, pyramidal or transverse

62
Q

What are important features of the history in a patient with a Le Fort fracture?

A

Mechanism of injury, airway patency, vision, cranial nerve function

63
Q

What are some symptoms associated with Le Fort fractures?

A

Loss of consciousness, confusion, dental occlusion, soft tissue swelling, bruising, haematoma, posterior retrusion of mid-face, upper airway compromise

ENT Medicine (22 decks)

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