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Otolaryngology > Throat and mouth emergencies > Flashcards

Throat and mouth emergencies Flashcards

1
Q

Who is most at risk of neck trauma?

A

Higher incidence in males, especially adolescents/YAs

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2
Q

What are some mechanisms of penetrating neck trauma?

A
  • Knife/BSW/MVA
  • Industrial accidents
  • Household accidents
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3
Q

What are some mechanisms of blunt neck trauma?

A
  • MVA (Motor vehicle accidents)
  • Sporting injuries (E.g. clothesline tackle)
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4
Q

What are the 3 classes of new trauma?

A
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5
Q

What are some affected structures within zone I neck trauma?

A
  • Trachea
  • Oesophagus
  • Thoracic duct
  • Thyroid
  • Vessels - brachiocephalic, subclavian, common carotid, thyrocervical trunk
  • Spinal cord
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6
Q

What are some affected structures within zone II neck trauma?

A
  • Larynx
  • Hypopharynx
  • CN X, XI, XII
  • Vessels - carotids, internal jugular
  • Spinal cord
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7
Q

What are some affected structures within zone III neck trauma?

A
  • Pharynx
  • Cranial nerves
  • Vessels - carotids, IJV, vertebral
  • Spinal cord
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8
Q

What are some important questions to ask in neck trauma?

A
  • Mechanism of injury
  • Pain
  • Aerodigestive tract - dyspnoea, hoarseness, dysphona, dysphagia, haemoptysis
  • CNS problems - paraethesias, weakness
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9
Q

What are some points to examine in neck trauma?

A
  • ABCDE
  • Inspect through platysma
  • Zone of neck
  • Bleeding/haematoma
  • Aerodigestive injuries
  • Neurological - power, sensation upper arm
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10
Q

What are some investigations required in neck trauma?

A
  • FBC, G+S/XM
  • CXR - haemopneumothorax, emphysema
  • CT angiogram
  • Urgent exploration - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
  • Laryngoscopy, bronchoscopy, pharyngoscopy, and oesophagoscopy
  • Angiography - embolise, occluse
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11
Q

What causes deep neck space infection?

A

Extension of infection from tonsil or oropharynx into deeper tissues e.g. from quinsy

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12
Q

What are some symptoms of deep neck space infection?

A
  • Sore throat
  • Unwell
  • Limited neck movement
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13
Q

What are some signs of deep neck space infection?

A
  • Febrile
  • Trismus
  • Red/tender neck
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14
Q

How is deep neck space infection managed?

A
  • IV access, bloods, fluid rehydration
  • IV antibiotics - co-amoxiclav or clinamycin
  • May need theatre for incision and drainage unless abscess is small and improves with conservative treatment
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15
Q

What is a possible complication of deep neck space infection?

A

Infection may extend into medistinum through fascial compartments

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16
Q

How are swallowed foreign bodies managed?

A
  • Impacted foreign body must be removed
  • May be able to remove without anaethesia but if in airway may need general anaethetic and bronchosopy
17
Q

What are some causes of airway obstruction?

A
  • Inflammatory/infective causes, allergy
  • Foreign bodies
  • Physical compression/invasion of airway
  • Trauma/iatrogenic trauma
  • Neurological causes
  • Neoplastic causes
  • Burns
  • Congenital airway pathology
18
Q

How does the larynx in a neonate differ from an adult?

A
  • Large head
  • Small nares
  • Neonates are obligate nasal breathers
  • Relatively large tongue
  • Small, soft larynx
  • Higher position of larynx (C1)
  • Weak neck muscles; floppy head
  • Narrow subglottis (3.5 mm at the cricoid)
19
Q

What are some symptoms of airway obstruction?

A
  • SOB on exertion
  • SOB at rest
  • Choking
  • Coughing
  • Inability to complete a sentance
20
Q

What are some signs of airway obstruction?

A
  • Sternal/subcostal recession
  • Tracheal tug
  • Dusky skin colour of skin
  • Pyrexia
  • Cyanosis
  • Stridor - high-pitched harsh noise due to turbulent airflow resulting from airway obstructions
  • Stertor (snoring) - low-pitched sonorous sound arising from nasopharyngeal airway e.g. child when sleeping due to OSA
21
Q

How is airway obstruction managed?

A
  • ABC resuscitation
  • High flow oxygen/heliox (79% helium and 21% oxygen)
  • Nebulised budesonide 2mg
  • Dexamethasone 0.15-0.6 mg/kg
  • Nebulised adrenaline 1:10000 (5ml)
  • Flexible fibre-optic endoscopy
  • Secure airway with ET tube/tracheostomy
  • Try and avoid tracheostomy
  • Treat underlying pathology
22
Q

How is supraglottitis managed?

A
  • Treat as foreign body but add:
    • Broad spectrum Abx
    • Airway plan
    • Senior help
23
Q

What is shown?

A

Supraglottitis

24
Q

What is stridor?

A

High pitched harsh noise due to turbulent airflow resulting from airway obstruction

25
Q

What is stertor?

A

Low pitched sonorous sound arising from nasopharyngeal airway (Snoring sound)

26
Q
A

Otolaryngology (23 decks)

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