Trauma Flashcards
management of a pinna haematoma
urgent same day ENT assessment
incision and drainage
consequence of untreated pinna haematoma
cauliflower ear
what is the most common site of bleeding in epistaxis
Little’s area / Keisselbach’s plexus
on the septal side
what vessels make up Little’s area on the septal wall
ant + post ethmoidal arteries (ophthalmic artery - ICA)
greater palatine artery (maxillary artery - ECA)
lateral + septal nasal arteries (facial artery - ECA)
causes of epistaxis
idiopathic iatrogenic trauma - digital and blunt inflammation tumour - SCC, angiofibroma (teen boys) environmental haematology - HHT autoimmune - GPA drugs - anticoagulants, decongestant sprays, cocaine, NSAIDs, antiplatelets liver damage ITP HHT
how can you classify epistaxis
anterior and posterior in origin
describe anterior epistaxis
more common
usually Little’s area
usually from one nostril anteriorly and then blood is swallowed after first aid is done
describe posterior epistaxis
heavy bleeding from both nostrils being swallowed from the onset
management of epistaxis
ABCDE - consider hypovolaemic shock
Pinch soft part of nose for 20 minutes leaning forward
Ice on back of neck/forehead or to swallow - vasoconstriction
spit out any blood
Topical vasoconstrictor - lidocaine and adrenaline
Blow nose
Cautery
Nasal packing
Operative management
what is involved in cautery in epistaxis management
topical vasoconstrictor (co-phenylcaine) is inserted into the nostrils
blow out any clots
silver nitrate cautery sticks are used (burns)
antiseptic is then applied
when would you use nasal packing
when a bleeding point cannot be identified and cannot be stopped by cautery
these can be anterior or posterior
nasal packing is painful, true or false
true
what else should be considered in epistaxis patients once bleeding resolves
anticoagulation therapy
list some post-epistaxis advice
avoid hot food/drinks
avoid hot baths/showers
rest for at least the next 48 hours
list operative management options for epistaxis
1st artery ligation - sphenopalatine, ECA
with rigid endoscope and diathermy / clips
2nd embolisation - IR
