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ENT SB > Trauma > Flashcards

Trauma Flashcards

1
Q

what are special features of infants airways

A 
Large head
Obligate nasal breather
Relatively large tongue
Small, soft larynx
Weak neck muscles; floppy head
Narrow subglottis
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2
Q

what can cause breathing difficulties in toddlers

A

adenotonsillar hypertrophy
foreign body
Respiratory Papillomatosis
Subglottis stenosis

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3
Q

what should be assessed in terms of telling if the patients breathing adequately

A

appearance
skin circulation
work of breathing

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4
Q

what is the pathway of a deteriorating infants breathing

A

Resp distress
» Resp failure
» resp arrest
» cardiac arrest

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5
Q

what needs to be known about nasal trauma

A 
MOI
When
Loss of consciousness
Epistaxis 
Breathing
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6
Q

what is important to ask about in nasal trauma

A

about sensation
possible to get numbness
eye movements

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7
Q

what must be excluded in nasal trauma

A

septal haematoma

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8
Q

what is a septal haematoma

A

cartilage gets blood supply from perichondrium
therefore, if there is bleeding underneath and the perichondrium is removed from cartilage wall
necrosis of the cartilage

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9
Q

Mx of nasal trauma

A 
No intervention
MUA nose (LA/GA)
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10
Q

how can epistaxis be treated if severe

A

anterior rhinoscopy

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11
Q

where are fractures often in CSF leaks

A

Cribriform plate

can be a complication of a broken nose

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12
Q

what is a pinna haematoma

A

blunt trauma resulting in swelling in subchondral space

cartilage can lose blood supply

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13
Q

Tx of pinna haematoma

A

Sub-perichondrial haematoma
Aspirate
Incision and drainage
Pressure dressing

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14
Q

Mx of ear lacerations

A

Debridement
Closure - primary or reconstruction
Antibiotics

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15
Q

Hx of temporal bone fracture

A 
Injury mechanism
Hearing loss
Facial palsy
Vertigo
CSF leak

Associated injuries

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16
Q

what can be a sign found on examination of a temporal bone fracture

A

Battle sign

- bruising over the mastoid process

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17
Q

what is the classifications of temporal bone fractures

A

Longitudinal vs transverse
Otic capsule involved
Otic capsule spared

18
Q

what are longitudinal fractures

A

80% of temporal bone fractures
lateral blows
Fracture line parallels the long axis of the petrous pyramid

19
Q

complications of longitudinal fracture

A

Bleeding from external canal due to laceration of skin and ear drum

Haemotympanum (conductive deafness)

Ossicular chain disruption (conductive deafness)

Facial palsy (20%)

CSF otorrhoea

20
Q

what are transverse fractures

A

20% of temporal bone fracture
frontal blows
Fracture at right angles to the long axis of the petrous pyramid

21
Q

complications of transverse fractures

A

Can cross the internal acoustic meatus causing damage to auditory and facial nerves

Sensorineural hearing loss due to damage to 8th cranial nerve

Facial nerve palsy (50%)

Vertigo

22
Q

what are 4 types of hearing loss

A

Conductive
Sensorineural
Mixed
Central

23
Q

what can cause conductive hearing loss

A

fluid - effusion, blood, CSF
TM perforation
Ossicular problem
Stapes Fixation - Otosclerosis

24
Q

what are the two components of sensorineural hearing loss

A

Sensory - cochlea

Neural - CNVIII

25
Q

Mx of temporal bone fracture

A

Facial nerve decompression

  • if no recovery
  • Ix with EMG studies

Manage CSF leak

Hearing restoration
- hearing aid or ossiculoplasty

26
Q

what are the second commonest mid facial fracture

A

Orbital floor fractures

27
Q

Ix of orbital blow out fractures

A

CT sinuses - ‘tear drop’ sign

28
Q

what are the 3 types of Le Fort fractures

A

I - Horizontal
II - Pyramidal
III - Transverse

29
Q

what is the imaging of choice in Le Fort fractures

A

CT imaging

30
Q

what are the 2 surgical options in Le Fort fractures

A

Vertical Buttresses

Horizontal Buttresses

31
Q

what type of surgery is a rhinoplasty

A

nasal reshape

32
Q

what is a mentoplasty

A

realgin position of the mandible

33
Q

what is otoplasty

A

pinning ears back

34
Q

what are the ways facial reconstruction can be done

A

primary closure
healing by secondary intention
skin graft
skin flap

35
Q

what is healing by secondary intention

A

when the wound is left to heal by itself

36
Q

what is the difference between skin graft and skin flap

A

graft - take tissue from donor area and move it, no blood supply, doesn’t always work

flap - locally moving tissue from an area of skin laxity into the recipient area, therefore has its own blood supply, get a better skin match.

37
Q

in head and neck cancer what are some red flags

A

Greater than 3 weeks

  • Sore throat
  • Hoarseness
  • Stridor
  • Difficulty swallowing
  • Lump in neck
  • Unilateral ear pain
38
Q

when should palliative care become involved in head and neck cancer

A

Around the time of diagnosis

During treatment

Following treatment

  • Disease free – treatment related symptoms
  • Recurrent disease

Metastatic disease and/or poor prognosis at diagnosis

When dying – “End of life care”

39
Q

what are the stages of the Analgesic ladder

A

Step 1
- non-opioid +/- adjuvant

Step 2

  • Opioid
    • non-opioid +/- adjuvant

Step 3

  • Stronger Opioid
  • +/- non-opioid +/- adjuvant
40
Q

what are adjacent analgesics and examples

A

Painkillers whose primary indication is for something other than pain

Anticonvulsants - gabapentin, pregabalin
Antidepressants -amitriptyline

ENT SB (9 decks)

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