Trauma Flashcards
What is the most common broken bone in the body?
Nose
Nose - common mechanism of injury
Fight
Sport
Falls
Nose - key history points
Any nosebleeds?
Any difficulties breathing?
Nose - clinical examination
Look at person from behind and tilt their head back - to view any deviation bruising swelling facial tenderness palpate around the orbit - check for bony orbital fracture look at extra ocular movements
Nose - Septal haematoma
Boggy swelling in one of the nasal apertures which may lead to destruction of the septum as the septal cartilage is avascular
How do you know if the nose is deviated?
The nose will be firm and not move
Nose - septal haematoma - management
Drain haematoma so that blood supply to the nose is not lost
Nasal fracture - fixed and one sided
Think of septal injury
Nasal fracture - which side do most noses deviate to?
Right side (left side is broken) - bcos most people are right handed during a fight
Nasal fracture - investigations?
Clinical diagnosis
Nasal fracture - management
Push nose back into place asap
Nasal fracture - complications
Epitaxis
CSF leak
Asomnia
Epitaxis - definition
Nose bleed
Epitaxis - common sites
Little’s area of anastomosis in the nasal septum
Venous plexus anastamosis
Internal and external carotid arteries
Epitaxis - how to stop the bleed
Squeeze lower part o the nose and the nosebleed should stop in around 10 mins
Sit patient forward
Epitaxis - management after bleeding has stopped
Clean out nose to find bleeding source
Remove blood clot (by suction or nose blowing)
Cauterise vessel - silver nitrate
DO NOT sedate patient
Ear - pinna haematoma
Bleeding under the perichondrium which has lifted the perichondrium up
Ear - what can pinna haematoma result in?
Cauliflower ear
- blood deposition
- calcium
- this can become an abcess if not drained
Ear - pinna haematoma cause
Rugby injury
Ear - pinna haematoma management
Aspirate or
Incision and drainage or
Pressure dressing
Ear - management of laceration
Local anaesthetic
Debridement
Put ear back in anatomical position of suturing
Wrap detached ear in gauze in box of ice
Give antibiotics for 5 days
Temporal bone fracture - points from history
Hearing loss
Facial palsy
Vertigo
CSF leak
Temporal bone fracture - clinical examination
Bruising behind the ear Bruising around the eyes Check tympanic membrane and ear canal function Test CNVII Hearing test
Temporal bone fracture - otic capsule involvement is more or less common?
Less common
Temporal bone fracture - otic capsule involvement
Transverse fracture
Due to frontal blow which causes the compression of the skull
Can cross the IAM causing damage to auditory and facial nerves
Vertigo
Temporal bone fracture - otic capsule not involved
Longitudinal fracture
Due to lateral blow
Can get bleeding from the external ear canal
Neck - zone 1
Lower part of neck
- trachea, oesophagus, thoracic duct, thyroid, spinal cord, brachiocephalic vein, subclavian vein, common carotid
Neck - zone 2
Most accessible area
- larynx, hydropharynx, spinal cord, CN X, CN XI, CNXII, carotids, internal jugular vein
Neck - zone 3
Upper part of the neck
- pharynx, carotids, IJV, spinal cord
Neck - penetrating injuries usually affect which neck zone?
Zone 2 (most accessible area of the neck)
Neck - how do you differentiate between proper / superficial penetrating injuries?
If penetration goes through the platysma then it is penetrating
Neck - penetrating injury management
Surgical exploration OR
Laryngoscopy, bronchoscopy OR
Angiography
Facial trauma - investigations
CT scan
Le Fort 1
Horizontal
Passes horizontally above teeth
Le Fort 2
Pyramidal
Can get significant airway obstruction
Le Fort 3
Craniofacial dysfunction
