Trauma Flashcards
If someone presents with nasal trauma, what are some things you should ask them about?
Mechanism of injury, epistaxis, loss of consciousness, breathing
What is the most important thing to exclude in an individual presenting with nasal trauma?
Septal haematoma
Where does the cartilage of the nasal septum get its blood supply from?
The perichondrium (connective tissue which envelopes cartilage which is not at a joint)
Describe what happens in septal haematoma?
There is a clot in the perichondrium which disrupts the blood supply to the nasal septum, causing it to die. If this cartilage then becomes necrosed, the nose can sink into the face within a month.
If a septal haematoma is present in nasal trauma, how is it managed?
Drainage
What investigation is used for a nasal fracture?
No investigation, clinical diagnosis
What should you assess in a patient with a nasal fracture? When should you see them again?
Assess for breathing and arrange follow up in 5-7 days
What are the management options for nasal fractures?
No intervention, or it can be physical straightened out, but only within the first 2 weeks
What are some complications of nasal fractures?
Epistaxis, CSF leak, anosmia
Epistaxis following a nasal fracture is most likely coming from which artery?
Anterior ethmoid artery
Anosmia is a result of a nasal fracture is usually caused by a fracture specifically where?
Cribiform plate
What are the management options for epistaxis?
Resuscitate on arrival if necessary. Then stop/slow the flow with pressure, ice, vasoconstrictors. Remove the clot with anterior rhinoscopy or cautery
What should you not do to a patient with epistaxis?
Sedate them
CSF leaks following a nasal fracture often resolve spontaneously. When may they need a repair?
If it is still occurring at 10 days
CSF leaks following nasal fractures are most likely to be caused by fractures specifically where?
Cribiform plate
Should you give prophylactic antibiotics for a CSF leak?
No
What is pinna haematoma also known as?
Cauliflower ear
What happens in pinna haematoma?
Sub-perichondral haematoma occurs which if left untreated can cause the cartilage to die and structures to calcify
What causes pinna haematoma to form?
Repeated pressure
How is pinna haematoma treated?
Aspiration, incision and drainage, pressure dressing
How are ear lacerations treated?
Debridement and closure usually under LA. Give antibiotics if the cartilage is exposed.
What ENT trauma injury is often sustained along with other significant head trauma?
Temporal bone fractures
What are some complications of temporal bone fractures?
Hearing loss, facial nerve palsy, vertigo, CSF leak
80% of temporal bone fractures are what type? How is this injury sustained?
Longitudinal from a lateral blow
Where is a longitudinal temporal bone fracture in relation to the long axis of the petrous pyramid?
Parallel
What are some complications of a longitudinal temporal bone fracture?
Conductive hearing loss, facial nerve palsy (20%), CSF otorrhoea
20% of temporal bone fractures are what type? How is this injury sustained?
Transverse from a frontal blow
Where is a transverse temporal bone fracture in relation to the long axis of the petrous pyramid?
Perpendicular
Transverse temporal bone fractures can cross the internal acoustic meatus causing damage to which structures?
CNs VII and VIII
What are some complications of a transverse temporal bone fracture?
Sensorineural hearing loss (can be due to damage to the cochlea or the nerve), facial nerve palsy (50%) and vertigo
Why do longitudinal temporal bone fractures cause conductive hearing loss?
Usually as a result of fluid e.g. blood, effusion or CSF. Can also be caused by a tympanic membrane rupture as a result of trauma or dislocation of the incus.
What is a common cause of conductive hearing loss which is related to the ossicles but not related to trauma?
Stapes fixation
Temporal bone fracture management is often delayed as a result of poly trauma. What may patients require?
Facial nerve decompression, CSF leak management, hearing restoration
What are some important structures found in zone 1 of the neck? (Lower zone)
Trachea, oesophagus, thyroid gland, lymphatic duct
What are some important structures found in zone 2 of the neck?
Larynx, hypopharynx, CNs X, XI and XII
Within which zone of the neck does most trauma occur? What is significant about that?
Zone 2- this is also the least life threatening zone
What is the important structure found in zone 3 of the neck?
Pharynx
Proper penetrating neck injury is when it has penetrated through where?
Platysma
How are maxillary fractures caused? What is the imaging of choice?
High energy blunt force injuries to the facial skeleton, do a CT
What is the weak point of the orbital floor?
Infraorbital groove
How should an orbital floor fracture be investigated for? What is the specific sign that it may show?
CT- tear drop sign
Blow out fractures involve where?
The medial wall and floor of the orbit
What defines an upper airway obstruction?
If it is above the vocal cords
What is recurrent respiratory papillomatosis? At what age is this classed as juvenile?
HPV infection causing wart like structures in the larynx which can be very destructive. < 12 = juvenile
If someone presents with head and neck burns, what is the best thing to do?
Intubate
