Lesson 1 - Emergency

Question 1

Most important in surgery

Answer 1

Breathing, then bleeding

Question 2

Why breathing problems in surgery

Answer 2

Prosthesis, sth in esophagus, upper jaw fracture (maxillary bone goes behind, close upper respiratory tract) chin fracture

Question 3

Bleeding

Answer 3

From gingiva - aspiration of blood; Tumour of tongue, oropharynx (epithelial tumours SCC) - obstruction

Question 4

Tracheotomy

Answer 4

an incision in the windpipe made to relieve an obstruction to breathing; in tumour; severe fractures and emergency; sometimes avoidable

Question 5

Trismus

Answer 5

commonly called lockjaw, is reduced opening of the jaws It may be caused by spasm of the muscles of mastication or a variety of other causes

Question 6

Large tumour treatment

Answer 6

3-4 cycles of neoadjuvant chemotherapy; surgery; radiotherapy

Question 7

Glossectomy

Answer 7

Surgical removal of all or part of the tongue + bilateral section in the neck (LN affected)

Question 8

Reconstruction

Answer 8

revascularization

Question 9

Microgenia

Answer 9

an unusually small or deformed chin

Question 10

Pierre Robin Sequence

Answer 10

retrognathia and glossoptosis, the mandible is a little bit backward than normal.
It’s caused because the mandible is behind the sternum when the baby is a fetus, so it’s not a real malformation but rather the consequence of a wrong position of the fetus in the uterus. This can in turn be caused by an abnormal iliac bone position in the mother, which blocks the fetus head from growing correctly

Question 11

Retrognathia

Answer 11

the lower jaw is set further back than the upper jaw, making it look like you have a severe overbite

Question 12

Glossoptosis

Answer 12

Posterior displacement of the tongue into the pharynx

Question 13

Intubation types

Answer 13

Oro- / Naso-tracheal

Question 14

Tracheotomy types

Answer 14

Emergency vs Election

Question 15

Emergency tracheotomy - tomb of surgeons

Answer 15

Very difficult stressful situation

Question 16

Triage

Answer 16

the process of quickly examining sick or injured people, for example after an accident or a battle, so that those who are in the most serious conditions receive care first

Question 17

Tube in for…

Answer 17

3-4 days max - coz the cuff can compress trachea

Question 18

Where tube goes?

Answer 18

tube should be inserted between the 1st and 2nd tracheal cartilage rings, in the membrane within them

Question 19

Direction of incission

Answer 19

horizontal more esthetic but in emergency vertical - easier to separate muscles; Watch out for isthmus oh thyroid (highly vascularized)

Question 20

After opening, trachea and muscles?

Answer 20

stitch muscles laterally and isthmus up (tracheotomy below usually)

Question 21

Good tips

Answer 21

better to ligate (non absorbable=silk) rather than electric scalpel - sometimes for months, management performed by nurse/another doctor

Question 22

Tracheal flap in U - position

Answer 22

easy to remove or place another tube

Question 23

Tube size

Answer 23

6 for women and children; 8-10 for men

Question 24

Percutaneous tracheotomy

Answer 24

true emergency; might be edema, hard to find area between thyroid and cricoid cartilage - (superior border cricoid inferior border thyroid) ; if too high, might damage vocal cords

Question 25

Complications of tracheotomy

Answer 25

Venous esp also arterial bleeding (this one immediate tho)
Subcutaneous emphysema (red, edema of eyelids etc)
Persistence of dyspnea
Granuloma, infections
Tube obstruction (with plug)
Oxygen dries the airways - if too much then plug develops

Question 26

Persistent dyspnea cause

Answer 26

usually mucous plugs; damage to the cuff (while inserting), tube close to tracheal wall ( inverse Y shape ) - if tube to long or hole too low - tube may reach the wall of bronchus - ventilation difficult

Question 27

Inner tube

Answer 27

Controcannula - can be removed and repositioned; but sometimes plug below the tube so removal doesn’t help;
sometimes plugs develop in the shape of trachea and bronchi

Question 28

Management of bleeding

Answer 28

direct compression
naso-maxillary plugging
external carotid artery ligature
embolization

Question 29

Vessels

Answer 29

Maxillary artery, (maxilla) facial artery (muscles of face) lingual artery for tongue; lesion in case of trauma, erosion due to tumour; usually terminal branches of maxillary (from nose) - inflatable plug to stop bleeding

Question 30

Ligation

Answer 30

metallic clip, knot - for facial artery bleeding

Question 31

Farabeuf Triangle

Answer 31

when bleed inside the tissue, tumour eroded carotid artery - incise neck, look for it – sternocleid - jugular - posteior belly of digastric – site of CAROTID ARTERY

Question 32

embolization

Answer 32

when can’t find the source of bleeding - radiology – contrast enhancement, metal coils,

Question 33

Loss of sight

Answer 33

trauma to all bones tht make up othalmic bone - 2main arteries in eyeball – internal bleeding, eyeball goes farward, optic nerve compressed - ischemia, 2-3 hours later eyesight loss (need to perform decompression of orbital wall)

Question 34

Direct hit on eyeball

Answer 34

ethmoidal artery damage - incision, release tendons of lateral and [medial] muscles

Question 35

Foreign body in eyeball

Answer 35

can migrate and cause infection and compression by pus and eyesight loss; in case of bullet the hit sterilizes the path

Question 36

sinusitis

Answer 36

infection of maxillary sinus, iatrogenic (during rehabilitation) or due to foreign body - can spread to eye and cause retrobulbar empyema

Question 37

Soft tissue lesions

Answer 37

Facial artery; look for facial nerve and branches, direct suture if possible, if no tissue - graft from another (sural, from the neck) – regrowth of neural axons; otherwise muscle atrophy

Question 38

autocrine transplants of muscles

Answer 38

if muscle atrophy, take from leg, then neurography on the new muscle, in 10 days muscle should start to contract – can just restore ability to smile but mimic and mouth closing - very complex

Question 39

Stab wounds in parotid gland - facial nerve palsy

Answer 39

not emergency but need to intervene within 10 days, otherwise recovery less than 50% - facial nerve passes and divides into two and then more branches - can recover smile ok but right and left face differs afterwards