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Emergency Med Exam 1 > HEENT Emergencies > Flashcards

HEENT Emergencies Flashcards

1
Q

What amount of those with head injury in the US have bleeding? What amount require intervention?

A

Bleeding: <10%
Intervention: <1%

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2
Q

Mechanism hx for head injury?

A

Assault w object? fall from height? MVC? GSW? sports?

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3
Q

LOC hx for head injury?

A

none, brief (<1min), prolonged, associated seizure ?

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4
Q

Relevant factor hx for head injury?

A

Helmet? seat belt?

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5
Q

Asscoaited sx hx for head injury?

A

N/V (# of projectile)? headache? soft tissue swelling (STS)/bruising? preceding event (syncope)?

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6
Q

Misc hx for head injury?

A

Prior head injury? current anticoagulants? age? distracting injuries? ETOH/drug use?

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7
Q

S/Sx of head injury?

A

Headache, confusion, light/sound sensitivity, fatigue/malaise, N/V

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8
Q

What to assess in PE for head injury?

A

Mental status (GCS), distracting injuries

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9
Q

What to inspect in PE for head injury?

A

Lacerations, foreign bodies, basilar skull fx (Battle sign, Raccoon eyes), hemotympanum, CSF leakage (clear rhinorrhea or otorrhea), facial bone injury, pupil size/reactivity

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10
Q

What to palpate for in PE for head injury?

A

Depressed skull fractures, foreign bodies, soft tissue swelling (STS), C-spine

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11
Q

What to focus on for neuro PE in head injury?

A

Gait, Rhomberg (balance), finger-to-nose, cognitive recall

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12
Q

DDx for head injury?

A

Contusion (soft tissue and vertebral), concussion, skull fx w or w/o intracranial bleed

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13
Q

How to begin work-up for head injury?

A

GCS (Glasgow coma scale) & clinical decision making

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14
Q

GCS

A
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15
Q

Clinical decision tools

A
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16
Q

What is a concussion?

A

Head injury resulting in transient alteration of cognitive abilities, motor function, and/or level of consciousness

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17
Q

What is a subarachnoid hemorrhage?

A

Tearing of pial vessels w/ subsequent tracking of blood in the subarachnoid space into the sulci and cisterns

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18
Q

What is a subdural hematoma?

A

Shear through the bridging veins with blood tracking along brain under the dura

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19
Q

What is an epidural hematoma?

A

Skull fracture leading to disruption of an artery & blood escapes from the artery, pushing the tightly adhered dura away from the calvarium

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20
Q

What are cerebral contusions?

A

Areas of punctuate hemorrhages and cerebral edema usually d/t acceleration-deceleration injuries against the bony internal surfaces of the cranium

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21
Q

If low risk, is workup for head injury necessary?

A

Not always, 3-4 hrs observation best

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22
Q

When to check coags with head injury?

A

If on coumadin or if bleed present

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23
Q

When to check CBC, chemistries, UA, tox-screen, ETOH, EKG, orthostatics for head injury?

A

If injury is secondary to another process

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24
Q

What to consider if head injury with children or elderly?

A

Abuse

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25
Q

Are skull plain films helpful in the work-up of head injury?

A

No, of little value

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26
Q

What other injury to consider along with head injury?

A

C-spine

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27
Q

What is the Banyan Brain Trauma Indicator (new test) for head injury?

A

Measures levels of two brain proteins (ubiquitan C-terminal hydrolase & glial fibrillary acidic protein) that are released after brain injury

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28
Q

What is SyncThink (new test) for head injury?

A

Ocular tracker concussion test

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29
Q

Mainstay of tx for concussion?

A

Rest and time (avoid exercise, TV, gaming until sx resolved for 24 hrs)
After: gradual return to activity & stop if sx resume

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30
Q

Concussion screening tools most useful with baseline?

A

MACE, SCAT, King-Devick, ImPACT

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31
Q

Tx for ICB (intracranial bleed)?

A

Emergent neurosurgery consult for possible defompression, intubation if GCS <8, seizure prophylaxis w/ phenytoin (Dilantin), anticoag reversal

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32
Q

How to reverse Warfarin in cases of ICB?

A

Vitamin K, FFP

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33
Q

How to reverse Heparin/LMWH in cases of ICB?

A

Protamine

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34
Q

How to reverse ASA/clopidogrel in cases of ICB?

A

Platelets

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35
Q

Head injury pathway

A
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36
Q

What is post-concussive syndrome?

A

Sx complex that continues beyond the expected 7-10d recovery period (25-30% of mild TBI pts)

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37
Q

Who is post concussive syndrome more common in?

A

Those w/ negative perceptions about traumatic experience, pre-existing stress, anxiety, depression

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38
Q

Somatic sx of post concussive syndrome?

A

Headache, insomnia, dizziness, nausea, fatigue, light/noise sensitivity

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39
Q

Cognitive sx of post concussive syndrome?

A

Attention/concentration/memory problems

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40
Q

Affective sx of post concussive syndrome?

A

Irritability, anxiety, depression, emotional liability

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41
Q

Tx for post concussive syndrome?

A

Focused on sx: analgesics, antidepressants, cognitive therapy, counseling

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42
Q

<1% of those on warfarin that receive a head injury will develop what?

A

Delayed ICB
*consider prolonged ED observation for 23hhr, admit those w/ significant injury or neurologic abnormalities w/ normal initial CT (rpt CT if sx worsen)

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43
Q

What occurs in the complication of deterioration post-ICB?

A

Progression of the ICB leading to hypoventilation/death

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44
Q

What disability can occur from head injuries?

A

Permanent neurologic or psychiatric deficits
(ex. CTE)

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45
Q

What is CTE?

A

Chronic traumatic encephalopathy- progressive disease secondary to repetitive trauma

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46
Q

What is a subconjunctival hemorrhage?

A

Collection of blood under conjunctiva from minor trauma, coughing, sneezing, etc
*no tx required

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47
Q

What is a hyphema?

A

Collection of blood in anterior chamber

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48
Q

Tx for hymphema?

A

Rest, head elevation, avoid ASA, optho follow up

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49
Q

Most common orbital fracture?

A

Orbital floor (blow-out fx)

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50
Q

Possible sx of orbital fracture?

A

Hyphema, ocular muscle entrapment, globe rupture

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51
Q

PE for orbital fracture?

A

Check EOMs, pupil shape

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52
Q

Tx for orbital fracture?

A

avoid nose blowing, etc.
Abx
Plastics or optho referral

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53
Q

Most corneal foreign bodies are ________

A

Superficial

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54
Q

Deformed pupil raises suspicion for what dx?

A

Corneal foreign body

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55
Q

PE for corneal foreign body?

A

Check under lids, document visual acuity PRIOR to meds

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56
Q

Procedure for corneal foreign body?

A

Anesthetic, fluorescein, blue light, cotton swab, 18gu needle, burr under slit lamp, irrigate
*rust ring needs to be removed

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57
Q

Tx for corneal foreign body?

A

Abx drops or ointment +/- cycloplegic, diclofenac, optho follow up

58
Q

How will corneal laceration appear?

A

Similar to abrasion but with a raised border

59
Q

How is a corneal laceration best visualized?

A

Under slit lamp

60
Q

What may be present with corneal laceration?

A

Seidel sign (dye dilutes aqueous humor streams down eye w/ gravity)

61
Q

Tx for corneal laceration?

A

Abx ointment/drops, optho referral for possible gluing, surg closure, or graft if large

62
Q

What is actinic (UV) keratitis?

A

UV burns of the cornea secondary to welding, sunlamps, snow reflection

63
Q

Which dx has diffuse punctate staining of fluorescein dye (usually bilaterally) on exam?

A

actinic (UV) keratitis

64
Q

Delay of onset of sx with actinic (UV) keratitis?

A

6-12 hrs

65
Q

Actinic (UV) keratitis usually resolves in what amount of time?

A

w/in 48 hrs

66
Q

Tx for actinic (UV) keratitis?

A

Atropine sulfate (Isopto Atropine), cyclopentolate (Cyclogyl), Abx drops, analgesics

67
Q

What kind of chemical eye injury is worse than acid?

A

Alkali

68
Q

How to manage chemical injury to the eye?

A

Immediate copious irrigation w/ Morgan lens if available (*until pH of 7 obtained 5 min after stopping)

69
Q

Tx for chemical injury to the eye?

A

Cycloplegics, analgesics, abx
-optho referral

70
Q

When to worry about periocular erythema?

A
71
Q

What is preseptal (periorbital) cellulitis?

A

Superficial infection around eye

72
Q

What is septal (orbital) cellulitis?

A

Deep space infection involving orbital muscles

73
Q

Cause of preseptal cellulitits?

A

Secondary to trauma or insect bite

74
Q

Cause of septal cellulitis?

A

Secondary to sinusitis or surgery

75
Q

Sx of preseptal cellulitis?

A

Superficial pain, lid edema, warmth, erythema, vision generally not affected

76
Q

Sx of septal cellulitis?

A

Deep pain, proptosis, chemosis, opthalmoplegia, diplopia, decreased vision

77
Q

Tx for preseptal cellulitis?

A

Clinda or Doxy alone
or
Bactrim + Amoxil PO
*close follow up

78
Q

Tx for septal cellulitis?

A

Vanco + Ceftriaxone IV
*optho consult

79
Q

What is an auricular (subchondral) hematoma aka cauliflower ear?

A

Collection of blood between cartilage and skin secondary to sheering trauma

80
Q

Tx for auricular (subchondral) hematoma?

A

Needle aspiration or I&D w/in 7 days (sooner = better), compression bandage post drain, daily re-checks for expanding hematoma

81
Q

Common ear foreign bodies?

A

Cerumen, insects, toys

82
Q

Retrieval options for ear foreign bodies?

A

Alligator forceps, ear curette, irrigation, suction

83
Q

What to do after extraction of ear foreign body?

A

Assess for additional retained material or soft tissue damage

84
Q

What temp of water for ear irrigation?

A

Warm

85
Q

What can be used as a cerumen softener?

A

Cerumenex, hydrogen peroxide, docusate (Colace)

86
Q

What to use along with curette while extracting foreign bodies from the ear?

A

Otoscope

87
Q

Hx/exam for nasal foreign body?

A

Witnessed event MC, sneezing, discomfort/pain, unilateral discharge, foul odor, epistaxis, mouth breathing, swelling

88
Q

Ddx for nasal foreign body?

A

Polyp, malignancy, abscess

89
Q

Work-up for nasal foreign body?

A

Thorough exam w/ good lighting
Imaging (CT/X-ray) if complicated

90
Q

Options for removal of nasal foreign body?

A

Mouth to mouth, katz extractor, ear curette, suction, ENT consult

91
Q

Complications of nasal foreign body?

A

May need sedation, infection (localized or toxic), bleeding, aspiration, necrosis (prolonged pressure, alkaline battery) w/ secondary synechia (scar band) resulting in obstruction

92
Q

What to consider w/ nasal foreign bodies?

A

Abx/ ENT follow up
*but most require nothing further

93
Q

Age distribution for epistaxis?

A

Bimodal: 2-10 y/o and >50 y/o

94
Q

Hx/causes of epistaxis?

A

Trauma, dry air/nasal O2, FB, structural abnormality (mass, telangtasia), drugs (blood thinners, steroid nasal spray, street drugs), bleeding disorders (if infant w/ unexplained bleeding), allergic rhibitis, HTN (?)

95
Q

Is most epistaxis anterior or posterior?

A

Anterior (>90%) MC in Kiesselbach plexus

96
Q

Work-up for epistaxis?

A

Most need nothing, Labs (CBC, bleeding panel) if warranted

97
Q

Exam for epistaxis?

A

Get supplies (ready to treat), pt sitting up in gown, good light, evaluate pharynx for any bleeding, check sptal wall (hematoma), clear nose (blow nose, suction)

98
Q

1st line tx for epistaxis?

A

Pressure

99
Q

Procedures for pressure w/ epistaxis?

A

Vasolene gauze, merocele, silver nitrate, rapid rhino, epistat, foley (for posterior)

100
Q

Patients with a disposition for epistaxis should be seen by who?

A

Emergent ENT consult

101
Q

Complications of epistaxis?

A

Poor control of bleed, unrecognized posterior bleed, obstruction, BP control, Bleeding disorders (need to reverse cause)

102
Q

Discharge of patient with epistaxis?

A

Recommend 15 min constant pressure if bleeding reoccurs
Humidifier/saline
If packing: follow up w/ ENT in 3-5d
+/- Abx

103
Q

How to stop bleeds from hemophelia?

A

DDAVP, Factor VIII, IX, FFP

104
Q

How to stop bleeds from thrombocytopenia/alcohol/anti-platelet meds?

A

Platelets

105
Q

Most suspected nasal bone fxs require what?

A

No tx

106
Q

What is needed if deformity is noted with nasal bone fx?

A

X-ray

107
Q

Displaced/depressed nasal fxs need what?

A

ENT or plastics follow up in 5-7d if cosmetics/function concern

108
Q

Always check for what with a nasal fx?

A

Septal wall hematoma

109
Q

What does a septal wall hematoma usually require?

A

Drainage, ENT follow up

110
Q

Complications of untreated septal hematoma?

A

Necrosis (disrupted blood supply leading to septal perf)

111
Q

Dental fracture class Ellis I?

A

Through enamel only
*non tender, no color change
*non emergent follow up

112
Q

Dental fracture Ellis II?

A

Enamel and dentin
*tender, yellow layer

113
Q

Tx for Ellis II dental fx?

A

Ca+ hydroxide paste, dental referral, may need possible root canal
+/- Abx

114
Q

Dental fracture Ellis III?

A

Enamel, dentin, and pulp
*tender, small dot of red visible

115
Q

Tx for Ellis III dental fx?

A

Ca+ paste, follow up w/in 24hr
+/- Abx

116
Q

What is subluxation?

A

Mobile angulation of tooth

117
Q

What us luxation?

A

Displaced angulation of tooth

118
Q

Tx for subluxation/luxation?

A

If loose or unstable –> Coe-Pak compound to splint, follow up w/ dentist

119
Q

What is intrusion?

A

Tooth that is pushed up into gum (suspect when abnormal spacing, alignment, or blood at gum)
*most stable

120
Q

What is avulsion?

A

Missing tooth (where is it??)

121
Q

What can occur as a result of intrusion?

A

Neurovascular compromise

122
Q

How to manage avulsion?

A

Milk or tooth saver X up to 12hrs and re-implant ASAP
*emergent oral surgery follow up

123
Q

What to use to splint traumatized teeth?

A

N-butyl-2-cyanocrylate tissue adhesive and skin closure strips

124
Q

Where is a lower dental block inserted?

A

Coronoid notch (alveolar nerves)
*angle near first and second premolar on opposite side

125
Q

Imaging for mandible fx?

A

Xray, panorex, or CT

126
Q

When is a mandible fx considered open?

A

If intraoral lac present

127
Q

What should you be concerned about w/ mandible fx?

A

Inferior alveolar nerve, parotid duct, or dental involvement

128
Q

Management of mandible fx?

A

Oral surgery follow up and Abx if open fx

129
Q

Classification for maxilla fx?

A

Le Fort Classification, at level of: teeth (I) , nasal bones (II), orbits (III)

130
Q

Is unstable maxilla fx, check for what?

A

CSF rhinorrhea or ocular involvement

131
Q

Common ingested foreign bodies in children? adults?

A

Children: coins
Adults: food impaction (meat)

132
Q

What may be useful in determining location if metal foreign body ingested?

A

X-ray

133
Q

Where are esophageal coins usually found? What about tracheal coins? (FB ingestion)

A

-Esophageal: coronal plane (round on PA)
-Tracheal: Sagittal plane (flat on PA)

134
Q

If vomiting shortly after drinking post-FB ingestion, what does this indicate?

A

Blockage
*requires endoscopy

135
Q

What may work for FB ingestion by decreasing LES pressure?

A

Glucagon

136
Q

What is important to know with ingested substance emergencies?

A

Intentional/accident (child protective or psych may be needed)? What type and amount?

137
Q

What to do (if indicated) for ingested substance emergency?

A

Endoscopy and laryngoscopy

138
Q

Severity of sx with ingested substance emergency usually correlates with ____________

A

degree of damage

139
Q

Rx for ingested substance emergency?

A

NPO, IV fluids, PPI, analgesics
**AVOID LAVAGE

140
Q

Complications of ingested substance emergency?

A

Perf with mediastinitis, pneumonitis, bleeding, esophageal-tracheal fistula, strictures, inc. risk of squamous carcinoma

Emergency Med Exam 1 (5 decks)

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