ENT Trauma Flashcards
What is needed for a history of nasal trauma?
mechanism of injury when LOC (loss of consciousness) Epistaxis? Breathing?
Examination?
Bruising swelling tenderness deviation (tilt head back to see clearer) facial tenderness infraorbital sensation CNs
How long can deviation be fixed?
2 weeks (after this the bones are set)
How would you improve visualisation of deviation?
tilt head back
How would you examine CNs?
eye movements - specify
How does a septal haematoma feel?
Boggy swelling
How does septal deviation feel?
Hard swelling
What is crucial about a septal haematoma?
Can cause septal abscess or perichondrium stripped from cartilage (loss of blood supply) and both can cause necrosis of the cartilage
Do you need to x-ray for nasal fracture?
No- clinical diagnosis
When can you accurately assess nasal deviation?
5-7 days after injury (allow for swelling to decrease)
How can you assess deviation?
Push back to straight
What is epistaxis?
Nose bleed
What is the commonest emergency in ENT?
epistaxis
How many anatomies do you have in the now?
2 - one at front and a venous at the back
Management of nose bleed?
try to arrest or slow bleed - squeeze tip and lean forward
How can you cauterise a vessel?
silver nitrate or diathermy
What does a rhino pack allow for?
allows you to put internal compression on the bleed (blow up a nasal tampon)
When do CSF leaks settle?
spontaneously within 10 days
What can cause CSF leaks?
if the fracture site is at the cribriform plate
What is an alternative name for a pinna haemotoma?
Cauliflower ear, caused by the blood up of blood under the … and will result in necrosis of the cartilage
What do you do to treat lacerations?
Debride, put it back into the anatomical position, and give prophylactic antibiotics
How do you transport a lacerated part of ear?
wrap in gauze or a sock and put in an ice box so it doesn’t get damaged by the ice
What do you want to ask in a temporal bone fracture?
mechanism hearing loss facial palsy? vertigo? CSF leak? any other ass injuries
What are the examination findings of a temporal bone fracture?
Bruising behind the ear and around eyes, asses facial nerve function
What are the 2 types of temporal fracture?
longitudinal (along axis of temporal bone)
transverse (across axis of temporal - could go through otic capsule)
What are most common fractures?
longitudinal
What is common in L fracture?
occicular chain disruption e.g. middle ear so results in conductive deafness
What are the 3 types of hearing loss?
NOT central
Conductive?
sound not transmitted effectively through the tympanic membrane due to fluid (1st in non-trauma), TM perforation, ossicular problem (most commonly the incus), if you have otosclerosis then this is 2nd most common in a non-trauma patient
Sensorineural?
Sensory - cochlea damage
Neural - damage to 8th CN
Management?
often delayed as poly trauma and common in RTA (may wake up 5 days later with a facial palsy)
May need facial nerve decompression
How can you restore hearing?
repair ossicular chain, hearing aid or ossiculoplasty
What are the 2 most common causes of neck trauma?
Penetrating (knife, self harm, household accidents etc)
Blunt (MVA or sports injuries)
Epidemiology of penetrating?
Males more than females
high mortality rate
Glasgow second most violent city in UK
What is Zone 1 of the neck?
Low, root of the neck
big arteries and veins, significant damage if here
Zone 2?
Biggest area, more accessible, not usually life threatening
Zone 3?
Quite protected, jaw to cranial base, significant injuries
History of neck injuries?
Mechanism
Pain?
Aerodigestive - dyspnoea, hoarseness (recurrent laryngeal)
CNS problems
What type of examination would you do?
ABCDE
What is the significance of the platysma?
Main muscle of the neck - if penetrate through then serious if no penetration then superficial
When would urgent exploration be required?
expanding haematoma, hypovolaemic shock, airway obstruction, blood in aero digestive tract (penetrating injury)
Would you remove the insulting instrument?
No as could be plugging the jugular or carotid
What sort of mech is required to fracture maxilla?
High energy blunt force
What is the commonest facial fractures?
- nasal
2. orbital
What sign will you see on CT of blow-out fracture?
tear-drop sign showing prolapse of orbital contents into the maxillary sinus
Le fort 1
Numbness
Le fort 2
pyramidal - whole of mid face can fall back, significant airway obstruction
Le fort 3
Literally have to hold whole of mid face forward to prevent airway obstruction
What does everyone get for a Le Fort fracture?
CT scan
What are vertical and horizontal buttresses?
if fracture put back into place along these butresses then outcome is quite good
