Trauma Flashcards
what are special features of infants airways
Large head Obligate nasal breather Relatively large tongue Small, soft larynx Weak neck muscles; floppy head Narrow subglottis
what can cause breathing difficulties in toddlers
adenotonsillar hypertrophy
foreign body
Respiratory Papillomatosis
Subglottis stenosis
what should be assessed in terms of telling if the patients breathing adequately
appearance
skin circulation
work of breathing
what is the pathway of a deteriorating infants breathing
Resp distress
» Resp failure
» resp arrest
» cardiac arrest
what needs to be known about nasal trauma
MOI When Loss of consciousness Epistaxis Breathing
what is important to ask about in nasal trauma
about sensation
possible to get numbness
eye movements
what must be excluded in nasal trauma
septal haematoma
what is a septal haematoma
cartilage gets blood supply from perichondrium
therefore, if there is bleeding underneath and the perichondrium is removed from cartilage wall
necrosis of the cartilage
Mx of nasal trauma
No intervention MUA nose (LA/GA)
how can epistaxis be treated if severe
anterior rhinoscopy
where are fractures often in CSF leaks
Cribriform plate
can be a complication of a broken nose
what is a pinna haematoma
blunt trauma resulting in swelling in subchondral space
cartilage can lose blood supply
Tx of pinna haematoma
Sub-perichondrial haematoma
Aspirate
Incision and drainage
Pressure dressing
Mx of ear lacerations
Debridement
Closure - primary or reconstruction
Antibiotics
Hx of temporal bone fracture
Injury mechanism Hearing loss Facial palsy Vertigo CSF leak
Associated injuries
what can be a sign found on examination of a temporal bone fracture
Battle sign
- bruising over the mastoid process
what is the classifications of temporal bone fractures
Longitudinal vs transverse
Otic capsule involved
Otic capsule spared
what are longitudinal fractures
80% of temporal bone fractures
lateral blows
Fracture line parallels the long axis of the petrous pyramid
complications of longitudinal fracture
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
what are transverse fractures
20% of temporal bone fracture
frontal blows
Fracture at right angles to the long axis of the petrous pyramid
complications of transverse fractures
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
what are 4 types of hearing loss
Conductive
Sensorineural
Mixed
Central
what can cause conductive hearing loss
fluid - effusion, blood, CSF
TM perforation
Ossicular problem
Stapes Fixation - Otosclerosis
what are the two components of sensorineural hearing loss
Sensory - cochlea
Neural - CNVIII
Mx of temporal bone fracture
Facial nerve decompression
- if no recovery
- Ix with EMG studies
Manage CSF leak
Hearing restoration
- hearing aid or ossiculoplasty
what are the second commonest mid facial fracture
Orbital floor fractures
Ix of orbital blow out fractures
CT sinuses - ‘tear drop’ sign
what are the 3 types of Le Fort fractures
I - Horizontal
II - Pyramidal
III - Transverse
what is the imaging of choice in Le Fort fractures
CT imaging
what are the 2 surgical options in Le Fort fractures
Vertical Buttresses
Horizontal Buttresses
what type of surgery is a rhinoplasty
nasal reshape
what is a mentoplasty
realgin position of the mandible
what is otoplasty
pinning ears back
what are the ways facial reconstruction can be done
primary closure
healing by secondary intention
skin graft
skin flap
what is healing by secondary intention
when the wound is left to heal by itself
what is the difference between skin graft and skin flap
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.
in head and neck cancer what are some red flags
Greater than 3 weeks
- Sore throat
- Hoarseness
- Stridor
- Difficulty swallowing
- Lump in neck
- Unilateral ear pain
when should palliative care become involved in head and neck cancer
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”
what are the stages of the Analgesic ladder
Step 1
- non-opioid +/- adjuvant
Step 2
- Opioid
- non-opioid +/- adjuvant
Step 3
- Stronger Opioid
- +/- non-opioid +/- adjuvant
what are adjacent analgesics and examples
Painkillers whose primary indication is for something other than pain
Anticonvulsants - gabapentin, pregabalin
Antidepressants -amitriptyline
