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ENT > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

1
Q

Define malacia

A

Abnormal softening of cartilage leads to a floppy collapsed airway

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2
Q

Why can neonates only breath through their nose?

A

Palate is at the level of the epiglottis

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3
Q

In neonates why is a narrowing concerning?

A

Resistance increases 4 fold as the airway narrows in diameter

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4
Q

Name the causes of airway obstruction

A
  • Inflammation
  • Foreign body
  • Compression/Invasion
  • Trauma
  • Neurological problem
  • Neoplasm
  • Burn
  • Congenital
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5
Q

State the signs and symptoms of airway obstruction

A
  • shortness of breath
  • coughing/chocking
  • inability to complete a sentence
  • sternal/subcostal recession
  • tracheal tug
  • dysphagia/dysphona
  • pyrexia
  • cyanosis
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6
Q

What is stridor?

A

High pitched harsh noise due to turbulent airflow resulting form airway obstruction

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7
Q

What is stertor?

A

Low pitched sonorous sound arising from nasopharyngeal airway

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8
Q

What is recurrent respiratory paillomatosis?

A

HPV warts on vocal cords

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9
Q

How does recurrent respiratory papillomatosis present?

A

School children - struggle to keep proper function of the larynx so their voice is persistently hoarse

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10
Q

What is subglottic stenosis?

A

Narrowing of airway below vocal cords (glottis) - surgical emergency

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11
Q

Who usually presents with subglottic stenosis?

A

Newborns, adults c40 years old, women with a history of small vessel vasculitis or sarcoidosis

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12
Q

What can trigger subglottic stenosis?

A

Reflux

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13
Q

What does treatment of subglottic stenosis involve?

A

CO2 laser and ballooning

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14
Q

What happens what hot air enters the trachea and lungs?

A

Coagulation and airway becomes sticky and swollen with can cause is to close up and be hard to support

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15
Q

How is an airway obstruction managed?

A 
ABCDE 
Heliox (helium and oxygen )
Steroids 
Adrenaline 
Airway endoscopy 
Avoid tracheostomy at all costs
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16
Q

What can be seen on examination in nasal acute pathology?

A

Bruising, swelling, tenderness, deviation, epistaxis, infraorbital sensation

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17
Q

How long after the nose injury is a patient seen?

A

5 days - to allow swelling and pain to go down

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18
Q

What is septal haematoma and what is the consequence if it is bilateral?

A

Collection of blood within the septum
Bilateral - blood supply from the perichondrium is compromised and the cartilage becomes necrotic giving a boggy swollen appearance

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19
Q

What is the management of a nasal fracture?

A

No imaging is required

Manipulation can be carried out between 5 and 20 days post injury

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20
Q

What are the complication of a nasal fracture?

A

Epistaxis, CSF leak, meningitis, anosmia (loss of sense of smell)

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21
Q

Why is the nose intensely vascularised?

A

Heating/humidifying requirements

22
Q

Where do most nose bleeds come from?

A

Anastomoses at the lower end of the nose

23
Q

How can most nose bleeds be managed?

A

Hypocratic method - pinching end of nose

24
Q

Describe the management of epistaxis

A 
Pressure, ice 
Nasal packing 
Cautery - silver nitrate/diathermy 
Topical vasoconstrictor (lignocaine, adrenaline)
Arterial ligation
25
Q

Which arteries may require ligation?

A

Sphenopalatine
Anterior ethmoid
External carotid

26
Q

What must not be done to a patient with nasal packing?

A

Sedation - will compromise the airway

27
Q

What systemic treatment can be used in epistaxis?

A

Reverse anticoagulants, correct abnormalities, platelet transfusion, treat hypertension

28
Q

Describe a CSF leak and the consequences of it

A

Spontaneous or traumatic due to increased ICP

Risk of bacteria getting in leading to meningitis so antibiotics may be prescribed

29
Q

What ear pathology common occurs in people who play contact sports?

A

Pinna Haematoma

30
Q

Describe pinna haematoma

A

Subperichondrial haematoma leads to fibrosis and chronic swelling

31
Q

How can a pinna haematoma be treated?

A

Aspiration or incision and drainage followed by a pressure dressing - 2 weeks off sport

32
Q

How are ear lacerations treated?

A

Decried and close with sutures may require secondary reconstruction or antibiotics if infected

33
Q

How can a temporal bone fracture present?

A

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

34
Q

What sign will be seen on examination in a temporal bone fracture?

A

Battle sign

35
Q

What are the two types of temporal bone fracture?

A

Longitudinal and transverse

36
Q

Describe a longitudinal fracture

A

Lateral blow - fracture line parallel the long axis of the petrous pyramid

37
Q

What can occur as a result of a longitudinal fracture?

A

Bleeding from external canal due to laceration of skin/TM
Conductive deafness (haemotypanum/ossicular chain disruption)
Facial palsy
CSF otorrhaeo

38
Q

Describe a transverse fracture

A

Frontal blow - fracture at right angle to the long axis of petrous pyramid

39
Q

What can occur as a result of a transverse fracture?

A

Fracture can cross the internal acoustic meatus and damage the auditory and facial nerves
Sensorineural hearing loss (CNVII)
Facial palsy
Vertigo

40
Q

What can become displaced in a transverse fracture?

A

Incus - EMG studies may be required to stimulate electrical activity

41
Q

What is the only foreign body that should not be removed immediately?

A

Batteries

42
Q

How is the extent of injury to the neck measured?

A

Position of injury in relation to the platysma muscle

43
Q

What investigations may be required in a patient with neck trauma?

A

Lateral and AP CXR

CT/MR angiogram

44
Q

How can a neck space infection occur?

A

Extension from the mouth (tonsil/oropharynx) into deeper tissue

45
Q

How will a neck abscess present?

A

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

46
Q

How are neck abscesses managed?

A

Admission and IV fluids and antibiotics

Co-amoxyclav or clindamycin

47
Q

Describe parotid and parapharyngeal space infections

A

Lymph nodes break down to a collection of pus forming an abscess which may spread to the mediastinum

48
Q

Why are maxillary fractures so serious?

A

Maxilla acts as a bridge between the cranial base and dental occlusal plane can be life threatening

49
Q

What causes maxillary fractures?

A

High energy blunt force injury

50
Q

On examination how will patients with facial trauma present?

A

Pain, visual problems, hypoaesthesia, perioribtial ecchymosis, oedema, enopthlmitis

51
Q

What are the three types of mid facial fracture?

A

Le fort 1,2,3,

52
Q

Name the drugs that can be used in airway obstruction

A

Heliox
Nebuliser budesonide
Dexamethasone
Adrenaline

ENT (11 decks)

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