ENT Emergencies Flashcards
Define malacia
Abnormal softening of cartilage leads to a floppy collapsed airway
Why can neonates only breath through their nose?
Palate is at the level of the epiglottis
In neonates why is a narrowing concerning?
Resistance increases 4 fold as the airway narrows in diameter
Name the causes of airway obstruction
- Inflammation
- Foreign body
- Compression/Invasion
- Trauma
- Neurological problem
- Neoplasm
- Burn
- Congenital
State the signs and symptoms of airway obstruction
- shortness of breath
- coughing/chocking
- inability to complete a sentence
- sternal/subcostal recession
- tracheal tug
- dysphagia/dysphona
- pyrexia
- cyanosis
What is stridor?
High pitched harsh noise due to turbulent airflow resulting form airway obstruction
What is stertor?
Low pitched sonorous sound arising from nasopharyngeal airway
What is recurrent respiratory paillomatosis?
HPV warts on vocal cords
How does recurrent respiratory papillomatosis present?
School children - struggle to keep proper function of the larynx so their voice is persistently hoarse
What is subglottic stenosis?
Narrowing of airway below vocal cords (glottis) - surgical emergency
Who usually presents with subglottic stenosis?
Newborns, adults c40 years old, women with a history of small vessel vasculitis or sarcoidosis
What can trigger subglottic stenosis?
Reflux
What does treatment of subglottic stenosis involve?
CO2 laser and ballooning
What happens what hot air enters the trachea and lungs?
Coagulation and airway becomes sticky and swollen with can cause is to close up and be hard to support
How is an airway obstruction managed?
ABCDE Heliox (helium and oxygen ) Steroids Adrenaline Airway endoscopy Avoid tracheostomy at all costs
What can be seen on examination in nasal acute pathology?
Bruising, swelling, tenderness, deviation, epistaxis, infraorbital sensation
How long after the nose injury is a patient seen?
5 days - to allow swelling and pain to go down
What is septal haematoma and what is the consequence if it is bilateral?
Collection of blood within the septum
Bilateral - blood supply from the perichondrium is compromised and the cartilage becomes necrotic giving a boggy swollen appearance
What is the management of a nasal fracture?
No imaging is required
Manipulation can be carried out between 5 and 20 days post injury
What are the complication of a nasal fracture?
Epistaxis, CSF leak, meningitis, anosmia (loss of sense of smell)
Why is the nose intensely vascularised?
Heating/humidifying requirements
Where do most nose bleeds come from?
Anastomoses at the lower end of the nose
How can most nose bleeds be managed?
Hypocratic method - pinching end of nose
Describe the management of epistaxis
Pressure, ice Nasal packing Cautery - silver nitrate/diathermy Topical vasoconstrictor (lignocaine, adrenaline) Arterial ligation
