ENT emergencies

Question 1

what clinical diagnosis indicates a nasal fracture

Answer 1

deviation and altered breathing

Question 2

how would you manage a deviated nasal fracture

Answer 2

manipulation within 3 weeks

Question 3

what are some serous complications of a nasal fracture

Answer 3

epitaxies, CSF leak, meningitis and ansomia (if cribriform plate fracture)

Question 4

what is epitaxis and what blood vessels are involved

Answer 4

acute haemorrhage from the nasal cavity often from trauma - sphenopalatine artery, ethmoid artery, greater palatine artery

Question 5

how do you arrest flow in epitaxis

Answer 5

pressure and ice, topical vasoconstrictor +/- LA (lignocaine and adrenaline)

Question 6

what do you do in epitaxis if bleeding is not controlled

Answer 6

admit, arterial ligation, platelet transfusion

Question 7

what are symptoms of a CSF leak after trauma and what sinuses are usually damaged

Answer 7

clear, thin, runny nose (rhinorrhea), frontal and sphenoid sinus

Question 8

what is a septal haematoma

Answer 8

build up of blood between nose and nostril - can cause cartilage death and collapse

Question 9

what is a pinna haematoma and what usually causes it

Answer 9

cauliflower ear - usually from blunt trauma

Question 10

how do you manage a pinna haematoma

Answer 10

aspirate, incision and drain, pressure dressing

Question 11

what commonly causes ear lacerations

Answer 11

blunt trauma, avulsion (torn off), dog bites, tissue loss

Question 12

how do you manage ear lacerations

Answer 12

debridement and closure, LA, topical antibiotics

Question 13

what can be seen on exam of a temporal bone fracture

Answer 13

battle sign bruise, TM and ear canal, CN VII nerve exam

Question 14

what is a longitudinal temporal bone fracture

Answer 14

lateral blow and fracture line parallel to long axis of petrous pyramid

Question 15

what symptoms are associated with a longitudinal temporal bone fracture

Answer 15

bleeding from external canal, hemotypanum (blood conductive hearing loss), ossicular chain disruption (conductive), facial palsy, CSF otorrhoea

Question 16

what is a tranverse temporal bone fracture

Answer 16

frontal blow, fracture at right angle to petrous pyramid

Question 17

what symptoms are associated with a tranverse temporal bone fracture

Answer 17

can cross internal acoustic meatus, sensorineural hearing loss from CNVIII, facial nerve palsy and vertigo

Question 18

how do you manage temporal bone fractures

Answer 18

facial nerve decompression, manage CSF leak, hearing restoration

Question 19

what exam and treatment is given in sudden sensorineural hearing loss

Answer 19

weber test, steroids

Question 20

what foreign body in the ear is an emergency

Answer 20

watch/ small battery - can cause severe burns

Question 21

what is a very common cause of neck laceration

Answer 21

males and knife crome

Question 22

what urgent investigations and management are done for neck lacerations

Answer 22

CXR for pneumothorax, CT angiogram, urgent exploration, angiography (embolise) and occlude)

Question 23

what is a deep neck space infection

Answer 23

extension of infection from tonsil/ oropharynx into deeper surrounding tissue

Question 24

what are symptoms of a deep neck space infection

Answer 24

sore throat, unwell, limited neck movement, febrile and red/ tender neck

Question 25

how do you manage a deep neck space infection

Answer 25

rehydrate, IV abs (co-amoixiclav and clindaymycin), theatre incision and drainage

Question 26

what are le fort fractures and what causes them

Answer 26

maxillary face fractures caused by high energy blunt trauma - can be v deadly

Question 27

what symptoms are seen in le fort fractures

Answer 27

pain, can’t see from swelling, hypoesthesia in infraorbital region, oedema (moon face), enopthalamos (posteriorly displaced eye)