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
MC orbital fracture?
Orbital floor (blowout)
26
Treatment of orbital blowout fracture
- Plastics or ophtho referral - Abx - Avoid nose blowing
27
In the setting of corneal FB, what does a deformed pupil raise concern for?
Intraocular FB
28
How to assess corneal FB?
- Check under lids - Document VA prior to instilling meds - Anesthetic, fluorescein, blue light, slit lamp
29
Treatment of corneal FB
- FB and rust ring needs to be removed - Abx drops or ointment - Ophtho F/U
30
How is a corneal laceration best visualized?
Under slit lamp
31
Treatment of corneal laceration
- Ophtho referral | - Abx ointment or drops
32
What is actinic (UV) keratitis?
UV burns of cornea secondary to welding, sunlamps or snow reflection
33
How does actinic keratitis present?
6-12 hr delayed onset of symptoms
34
How is actinic keratitis assessed?
Diffuse punctate staining of fluorescein (usually bilat)
35
Treatment of actinic keratitis
- Usually resolves w/in 48 hrs - Cycloplegic and abx drops - Analgesics
36
What type of chemical is worse for ocular injury?
Alkali worse than acid
37
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
38
What is subchondral hematoma?
- Cauliflower ear | - Collection of blood b/w cartilage and skin secondary to shearing trauma
39
Treatment of subchondral hematoma
- Needle aspiration or I&D within 7 days - Sooner is better - Compression bandage after drainage w/daily rechecks
40
Treatment of epistaxis?
Pressure
41
How are dental fractures classified?
Ellis I, II, III
42
Ellis I fracture
- Dental fx thru enamel only | - Non emergent f/u
43
Ellis II fracture
- Dental fx of enamel and dentin | - Ca hydroxide paste, dental referral (may need root canal)
44
Ellis III fracture
- Dental fx of enamel, dentin, pulp | - Ca hydroxide paste, f/u within 24 hrs
45
Subluxation vs. luxation of tooth
-Subluxation is mobile -Luxation is displaced (angulation of a tooth)
46
What is an intrusion?
- Tooth pushed up/into gum - Most are stable - F/U still required
47
What is an avulsion of tooth?
Missing tooth
48
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
49
How are maxilla fractures classified?
Le Fort Classification | teeth, nasal bones, orbits
50
How to tell esophageal FB vs. tracheal on x-ray?
- Round is usually esophageal | - Flat is usually tracheal