ENT EMERGENCIES! AHHHHH

Question 1

Why should NG tubes be avoided until extent of trauma is known?

Answer 1

They can pass thru cribiform plate into BRAIN! THE EFFING BRAIN. DO YOU WANT TO PUT AN NG TUBE INTO THEIR BRAIN?

Question 2

Septal Hematoma

Answer 2

Occur from trauma to anterior nasal septum.
Nasal fracture
Occur more easily in kids

Question 3

Septal Hematoma Tx

Answer 3

Drain and pack
Abx if abscess suspected
If not drained, can form abscess, perforate septum or make deformity.

Question 4

Nasal fracture

Answer 4

Usually diagnosed clinically

Reduce 2-10 days post injury

Question 5

Auricular Hematoma

Answer 5

Direct trauma to auricle
Separation of cartilage from perichondrium resulting in avascular necrosis
Abx to cover staph
drain within 7 days

Question 6

Cauliflower Ear

Answer 6

Failure to drain hematoma stimulates cartilage growth.

Protection from trauma is key

Question 7

Basilar skull fractures

Answer 7

Secondary to fracture in other skull bones

Temporal bone is generally involved

Question 8

Hemotympanum

Answer 8

Indication of basilar skull fx and middle ear injury.

Blood behind tympanic membrane

Question 9

Battle sign

Answer 9

Hematoma behind ear
Indicative of basilar skull fx
Occurs 6-12 hrs after injury

Question 10

Assessing for mandibular fx

Answer 10

2nd most common facial fx

Tongue blade test

Question 11

Most common site for epistaxis?

Answer 11

Kiesselback’s plexus

Question 12

Epistaxis initial mgmt

Answer 12

Have pt blow nose
Spray with afrin
Lean forward, pinch nares together
silver nitrate cautery
Nasal packing for 48 hrs if persistent

Question 13

Pott’s puffy tumor

Answer 13

Tumor over sinuses
Complication of sinusitis or trauma
Osteomyelitis of frontal bone
Can lead to brain abscess

Question 14

7th (facial) Nerve Palsy

Answer 14

Most cases are idiopathic
Sudden onset is hallmark
Consider lyme dz, HSV
R/O tumor
80% recover fully
Use steroids

Question 15

Facial cellulitis

Answer 15

Most commonly strep and staph
Can progress rapidly
Treat with abx
Admit?

Question 16

Which abx should not be used in ear with perforated TM?

Answer 16

Gentamycin - ototoxic

Question 17

Foul smelling unilateral rhinorrhea in child =?

Answer 17

Foreign body

Question 18

Retropharyngeal abscess

Answer 18

Serious infection of the retropharyngeal area
Caused by lymph nodes (usually in kids)
or Penetrating trauma, tooth infection

Question 19

Retropharyngeal abscess s/s

Answer 19

Fever
dysphagia
neck pain, decreased rom
ST
muffled voice
resp. distress

Question 20

Retropharyngeal abscess imaging

Answer 20

CT is gold standard

Can do lateral soft tissue x-ray

Question 21

Retropharyngeal abscess tx

Answer 21

ENT consult
Surgical I&D
IV Abx (clinda)

Question 22

Retropharyngeal abscess complications

Answer 22

Extension of infxn to mediastinum
Upper airway asphyxia
Sudden rupture

Question 23

Airway for neck trauma?

Answer 23

Tracheotomy

Not intubation, not crich