ENT trauma Flashcards
When is the best time to asses nasal trauma?
immediately or 5 days after
What should be elicited in the history of a nasal trauma?
mechanism of injury; when occured; LOC; epistaxis- has it recurred; breathing; discharge
What should be done on exam of nasal trauma?
infraoribtal sensation; facial tenderness- esp around orbits; CNs; EXCLUDE septal haematoma
Why is septal haematoma an emergency?
septal cartilage is avascular- gets blood from the periochondrium- if haeamatoma separates cartilage from perichondrium- septum loses blood supper and will necrose and abscess- loss of structure of nose and potential for intracranial infection
What would indicate a swelling is a septal haematoma rather than a bony swelling?
a boggy feeling- haematoma
How can deviation folloing a nasal # be fixed?
within 2 or 3 weeks, digital manipulation to straighten the nasal bones
What are the complications of nasal# ?
epistaxis; CSF leak; meningitis; anosmia
What are the arteries that supply the nasal septum?
sphenopalatine artery; ethmoid artery greater palatine artery
How can blood flow be arrested or slowed in epistaxis?
pressure; ice; topical vasoconstrictor +/- LA; remove clot; cautery; rapid rhino pack
What is the likely site of # in a CSF leak?
cribiform plate
How is a septal haematoma treated?
drainage
What is the treatemtn for a sub-perichondrial haematoma?
aspirate or incision and drainage or pressure dressing
What is the management of lacerations?
debridement; closure- primary or reconstruction; LA; antibiotics if affects cartilage
What is the typical bruising pattern seen with a temporal bone #?
battle sign behind the ear
What should be checked in a temproal bone# ?
coniditon of TM and ear canal; VII; hearing
How are temporal bone #s classified?
otic capsule invovled/spared or longitudinal/ transver
What type of blow causes a longitudinal #?
lateral blow
What are the symptoms of a longitudinal #?
bleeding from external canal due to laceration of skin and ear drum; conductive deafness (haemotympanum and ossicular chain disruption); facial palsy; CSF otorrhoea
What type of blow causes of transvers #?
frontal blow
What are hte symptosm of a transverse #?
SNHL and facial nerve palsy due to # crossing IAM; vertigo
What are the causes of conductive HL?
fluid- effusion; blood; CSF; TM perforation; ossicular disruption/fixation; stapes fixation- otosclerosis
what are the acuses of SNHL?
sensory-cochlea; neural- VIII
What is found in zone 1?
trachea;oesophagus; thoracic duct; vessels- bachiocephalic, subclavian; common carotid; spinal cord
What is found in zone 2?
larynx; hypopharynx; CN X; XI; XII; vessels - carotids; internal jugular; spincal cord1
What is found in zone 3?
pharynx; CNs; vessels- carotids; IJV; spinal cord
What should be looked at in a neck trauma?
aerodigestive tract- dyspnoea; hoarsenss; dysphonia; dysphagia; haemoptyssi
What is zone 2?
mandible to cricoid
What is the commonest zone affected by neck trauma?
zone 2
What is platysma?
muscle that wraps around the neck
When should an urgent exploration be undertaken in neck trauma?
expanding haematoma (vascular compromise); hypovolaemic shock; airway obstruction; blood in aerodigestive tract
How can urgent exploration be undertaken?
laryngoscopy; bronchoscopy; pharyngoscopy; oesophagoscopy
Why is the maxilla importnat?
a bridge between the cranial base and the dental occlusal plane
What is the second commonest midfacial #?
orbital floor #s
What is the weak point in the orbit?
infraorbital groove
What is the sign on CT of oribtal #?
tear drop sign into the sinuses
When would surgical repair happen in orbital #s?
if there is entrapment; a large defect or significant enophthalmos
What are the 3 types of Le Fort #s?
horizontal (maxilla); pyramidal; transverse
What is the imaging of choice with facial fractures?
CT
What is the surgery for Le Fort #s?
vertical and horizontal buttresses- reduce # and fix
What are the differences between adult and neonate ENT?
large head; small nares; relatively large tongue; small, soft larynx; weak neck muscles; narrow subglottis
What type of breathing do neonates prefeR?
neonates are obligate nasal breathers
What is Poiseuille’s equation?
air flow resistance- 1/r4
What is the difference bewteen stridor and stertor?
although both are noisy breathing, stertor is low pitched from nasopharyngeal blockage whereas stridor is a high pitched nosie dur to airway obstruction
What is Bedrnoulli’s theorem?
if air passes through a tube which has constrictions, the velocity of gas increases at the level of the narrowing, and in order to preserve the law of conservation of energy, the local gas pressure falls.
How is a basic assessment of breathing carried out?
appearance; work of breathing; skin circulation`
How does respiratory distress lead to cardiac arrest?
respiratory distress– respiratory failure– respiratory arrest– cardiac arrest
What is the most important thing to do with acute epiglottitis?
secure the airway
What is heliox?
a combination of helium and oxygen which is thinner air and so easier to breathe
