HEENT Emergencies Flashcards
How can LOC be described with a head injury?
- None
- Brief (less than 1 min)
- Prolonged
- Associated seizure activity
Associated s/s with head injury?
- Nausea
- Vomiting (number, projectile)
- H/A
- Swelling/bruising
- Preceding event (syncope)
What does the battle sign or raccoon eyes indicate?
Basilar skull fracture
battle = mastoid ecchymosis
Define concussion
Head injury resulting in a transient alteration in cognitive abilities, motor function, and/or LOC
Define subarachnoid hemorrhage
Tearing of pial vessels w/subsequent tracking of blood in subarachnoid space
Define subdural hematoma
Shear through the bridging veins with blood tracking along the brain under the dura
Define epidural hematoma
Skull fracture disrupts an artery and blood escapes from the artery pushing the dura away from calvarium
Define cerebral contusion
- Area of punctuate hemorrhages and cerebral edema
- Typically due to acceleration-deceleration injuries
What can be used to determine if a CT is indicated with head injury in adults?
- Canadian CT Head Rules
- NEXUS II
- New Orleans Criteria
What can be used to determine if a CT is indicated with head injury in children?
PECARN criteria
When are skull plain films useful in head injury?
For foreign body only if no CT planned (otherwise, of little value)
Treatment of concussion?
- Rest and time
- Avoid exercise, TV, gaming, reading until all symptoms have resolved for 24 hrs
Treatment of intracranial bleed?
- Emergent neurosurgery consult for possible decompression
- Intubation to assist oxygenation or protect airway
What GCS score indicates intubation?
Less than 8
What tools can be used for concussion screening?
SKIM
- SCAT
- King-Devick
- ImPACT
- MACE
Concussion screening tools are most useful when?
With baseline
Describe post-concussive syndrome
Symptom complex that continues beyond the expected 7 to 10 day recovery period
Who is MC affected by post-concussive syndrome?
Patients with negative perceptions about their traumatic episode and/or those with pre-existing stress, anxiety, depression
Treatment of post-concussive syndrome?
Focused on symptoms - analgesics, antidepressants, cognitive therapy
Describe delayed ICB
Complication of a head injury seen in less than 1% of those on warfarin
Treatment of delayed ICB
Consider prolonged ED observation or 24 hr admit
Types of orbital trauma
- Subconjunctival hemorrhage
- Hyphema
- Orbital fractures
Treatment of subconjunctival hemorrhage
No treatment required
Treatment of hyphema
- Ophtho consult
- Rest, head elevation, avoid ASA
MC orbital fracture?
Orbital floor (blowout)
Treatment of orbital blowout fracture
- Plastics or ophtho referral
- Abx
- Avoid nose blowing
In the setting of corneal FB, what does a deformed pupil raise concern for?
Intraocular FB
How to assess corneal FB?
- Check under lids
- Document VA prior to instilling meds
- Anesthetic, fluorescein, blue light, slit lamp
Treatment of corneal FB
- FB and rust ring needs to be removed
- Abx drops or ointment
- Ophtho F/U
How is a corneal laceration best visualized?
Under slit lamp
Treatment of corneal laceration
- Ophtho referral
- Abx ointment or drops
What is actinic (UV) keratitis?
UV burns of cornea secondary to welding, sunlamps or snow reflection
How does actinic keratitis present?
6-12 hr delayed onset of symptoms
How is actinic keratitis assessed?
Diffuse punctate staining of fluorescein (usually bilat)
Treatment of actinic keratitis
- Usually resolves w/in 48 hrs
- Cycloplegic and abx drops
- Analgesics
What type of chemical is worse for ocular injury?
Alkali worse than acid
Treatment of chemical ocular injury
- Immediate, copious irrigation w/Morgan lens (if available) until pH of 7 obtained 5 min after stopping
- Cycloplegics, analgesics, abx
- Ophtho referral
What is subchondral hematoma?
- Cauliflower ear
- Collection of blood b/w cartilage and skin secondary to shearing trauma
Treatment of subchondral hematoma
- Needle aspiration or I&D within 7 days
- Sooner is better
- Compression bandage after drainage w/daily rechecks
Treatment of epistaxis?
Pressure
How are dental fractures classified?
Ellis I, II, III
Ellis I fracture
- Dental fx thru enamel only
- Non emergent f/u
Ellis II fracture
- Dental fx of enamel and dentin
- Ca hydroxide paste, dental referral (may need root canal)
Ellis III fracture
- Dental fx of enamel, dentin, pulp
- Ca hydroxide paste, f/u within 24 hrs
Subluxation vs. luxation of tooth
-Subluxation is mobile
-Luxation is displaced
(angulation of a tooth)
What is an intrusion?
- Tooth pushed up/into gum
- Most are stable
- F/U still required
What is an avulsion of tooth?
Missing tooth
Treatment of avulsion of tooth
- If tooth available, store in milk or toothsaver X up to 12 hrs
- Re-implant ASAP
- Emergent oral surgery f/u
How are maxilla fractures classified?
Le Fort Classification
teeth, nasal bones, orbits
How to tell esophageal FB vs. tracheal on x-ray?
- Round is usually esophageal
- Flat is usually tracheal
