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EM - Exam 1 > HEENT Emergencies > Flashcards

HEENT Emergencies Flashcards

1
Q

How can LOC be described with a head injury?

A
  • None
  • Brief (less than 1 min)
  • Prolonged
  • Associated seizure activity
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2
Q

Associated s/s with head injury?

A
  • Nausea
  • Vomiting (number, projectile)
  • H/A
  • Swelling/bruising
  • Preceding event (syncope)
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3
Q

What does the battle sign or raccoon eyes indicate?

A

Basilar skull fracture

battle = mastoid ecchymosis

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4
Q

Define concussion

A

Head injury resulting in a transient alteration in cognitive abilities, motor function, and/or LOC

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5
Q

Define subarachnoid hemorrhage

A

Tearing of pial vessels w/subsequent tracking of blood in subarachnoid space

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6
Q

Define subdural hematoma

A

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

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7
Q

Define epidural hematoma

A

Skull fracture disrupts an artery and blood escapes from the artery pushing the dura away from calvarium

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8
Q

Define cerebral contusion

A
  • Area of punctuate hemorrhages and cerebral edema

- Typically due to acceleration-deceleration injuries

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9
Q

What can be used to determine if a CT is indicated with head injury in adults?

A
  • Canadian CT Head Rules
  • NEXUS II
  • New Orleans Criteria
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10
Q

What can be used to determine if a CT is indicated with head injury in children?

A

PECARN criteria

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11
Q

When are skull plain films useful in head injury?

A

For foreign body only if no CT planned (otherwise, of little value)

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12
Q

Treatment of concussion?

A
  • Rest and time

- Avoid exercise, TV, gaming, reading until all symptoms have resolved for 24 hrs

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13
Q

Treatment of intracranial bleed?

A
  • Emergent neurosurgery consult for possible decompression

- Intubation to assist oxygenation or protect airway

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14
Q

What GCS score indicates intubation?

A

Less than 8

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15
Q

What tools can be used for concussion screening?

A

SKIM

  • SCAT
  • King-Devick
  • ImPACT
  • MACE
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16
Q

Concussion screening tools are most useful when?

A

With baseline

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17
Q

Describe post-concussive syndrome

A

Symptom complex that continues beyond the expected 7 to 10 day recovery period

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18
Q

Who is MC affected by post-concussive syndrome?

A

Patients with negative perceptions about their traumatic episode and/or those with pre-existing stress, anxiety, depression

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19
Q

Treatment of post-concussive syndrome?

A

Focused on symptoms - analgesics, antidepressants, cognitive therapy

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20
Q

Describe delayed ICB

A

Complication of a head injury seen in less than 1% of those on warfarin

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21
Q

Treatment of delayed ICB

A

Consider prolonged ED observation or 24 hr admit

22
Q

Types of orbital trauma

A
  • Subconjunctival hemorrhage
  • Hyphema
  • Orbital fractures
23
Q

Treatment of subconjunctival hemorrhage

A

No treatment required

24
Q

Treatment of hyphema

A
  • Ophtho consult

- Rest, head elevation, avoid ASA

25
Q

MC orbital fracture?

A

Orbital floor (blowout)

26
Q

Treatment of orbital blowout fracture

A
  • Plastics or ophtho referral
  • Abx
  • Avoid nose blowing
27
Q

In the setting of corneal FB, what does a deformed pupil raise concern for?

A

Intraocular FB

28
Q

How to assess corneal FB?

A
  • Check under lids
  • Document VA prior to instilling meds
  • Anesthetic, fluorescein, blue light, slit lamp
29
Q

Treatment of corneal FB

A
  • FB and rust ring needs to be removed
  • Abx drops or ointment
  • Ophtho F/U
30
Q

How is a corneal laceration best visualized?

A

Under slit lamp

31
Q

Treatment of corneal laceration

A
  • Ophtho referral

- Abx ointment or drops

32
Q

What is actinic (UV) keratitis?

A

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

33
Q

How does actinic keratitis present?

A

6-12 hr delayed onset of symptoms

34
Q

How is actinic keratitis assessed?

A

Diffuse punctate staining of fluorescein (usually bilat)

35
Q

Treatment of actinic keratitis

A
  • Usually resolves w/in 48 hrs
  • Cycloplegic and abx drops
  • Analgesics
36
Q

What type of chemical is worse for ocular injury?

A

Alkali worse than acid

37
Q

Treatment of chemical ocular injury

A
  • Immediate, copious irrigation w/Morgan lens (if available) until pH of 7 obtained 5 min after stopping
  • Cycloplegics, analgesics, abx
  • Ophtho referral
38
Q

What is subchondral hematoma?

A
  • Cauliflower ear

- Collection of blood b/w cartilage and skin secondary to shearing trauma

39
Q

Treatment of subchondral hematoma

A
  • Needle aspiration or I&D within 7 days
  • Sooner is better
  • Compression bandage after drainage w/daily rechecks
40
Q

Treatment of epistaxis?

A

Pressure

41
Q

How are dental fractures classified?

A

Ellis I, II, III

42
Q

Ellis I fracture

A
  • Dental fx thru enamel only

- Non emergent f/u

43
Q

Ellis II fracture

A
  • Dental fx of enamel and dentin

- Ca hydroxide paste, dental referral (may need root canal)

44
Q

Ellis III fracture

A
  • Dental fx of enamel, dentin, pulp

- Ca hydroxide paste, f/u within 24 hrs

45
Q

Subluxation vs. luxation of tooth

A

-Subluxation is mobile
-Luxation is displaced
(angulation of a tooth)

46
Q

What is an intrusion?

A
  • Tooth pushed up/into gum
  • Most are stable
  • F/U still required
47
Q

What is an avulsion of tooth?

A

Missing tooth

48
Q

Treatment of avulsion of tooth

A
  • If tooth available, store in milk or toothsaver X up to 12 hrs
  • Re-implant ASAP
  • Emergent oral surgery f/u
49
Q

How are maxilla fractures classified?

A

Le Fort Classification

teeth, nasal bones, orbits

50
Q

How to tell esophageal FB vs. tracheal on x-ray?

A
  • Round is usually esophageal

- Flat is usually tracheal

EM - Exam 1 (5 decks)

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