Trauma Flashcards
local cause of epistaxis
idiopathic truamatic inflammatory foreign body tumour
systemic cause epistaxis
anticoagulants clotting issues liver disease haemophilia HHT leukaemia thrombocytopaenia arteriosclerosis wegners granulomatosis HTN
management local epistaxis
external pressure ice cautery packing remove clots with suction lignocaine, adrenaline
management of distant epistaxis
sphenopalatine artery ligation
ant ethmoidal artery ligation
external carotid/maxillary ligation
systemivc management of epistaxis
reverse anticoagulants correct clotting tranexamic acid platelet transfusion treat cause treat HTN
questions to ask about ENT trauma
mechanism when LOC epistaxis breatihng bruising/swelling tenderness deviation infraorbital sensation cranial nerves?
what is a septal haematoma
result of inflammation to mucosa supplying nasal cartilage leading to nasal collapse
can also become infected and spread to the danger traingle
what factors are setting the nose based off
breathing, cosmesis and deviation
when would you consider resetting the nose
either immediately after or within 7-14 days
complications of nasal fracture
epistaxis
CSF leak
meningitis
anosmia with crib plate fracture
blood tests during admission for epistaxis
FBC, G&S, XM
most common site for CSF leak and management
cribiform plate
usually settles but may need repair within 7 days
do not give abx as can mask a meningitis
what is a pinna haematoma and how would you manage it
avascular cartilage cannot receive nutrient from mucosa due to trauma
aspirate, incision and drainage
pressure dressing
management of lacteration to ear
debride
local anaesthetic
Abx
primary or reconstructive tissue repair
key questions in temporal bone fracture
facial palsy CSF leak hearing loss vertigo mechanism
features of temporal bone fracture on examination
battles sign
look at TM and canal
test CN VII and assess palsy
hearing test
what is worse, progressive facial nerve palsy or immediate
immediate, indicates severe damage to the facial nerve
complications of a longitudinal temporal bone fracturr
most common
facial nerve palsy
haemotympanum
ossicular chain dysruption
mechanism and complications of a transverse temporal bone fracture
frontal blow
cross IAM to damage auditory/facial nerve
facial nerve palsy/vertigo
management of sudden sensorineural hearing loss?
1mg/kg steroid and intratympanic treatment
what foreign body MUST be removed with immediate effect
button batteries, organ threatening
managing live animals in the ear?
drown them in oil and remove in urgent clinic
demographic for penetrating neck trauma
GSW, knife
Males
younger
aerodigestive features of penetrating neck trauma
SOB
hoarse
dysphonia
dysphagia
Zone I area of penetrating neck trauma
cricoid to sternum and clavicle
trachea, oesophagus, thoracic duct, thyroid, great vessels, cord
Zone II area of penetrating neck trauma
cricoid to hyoid
larynx
hyopharynx
CN X, IX, XII
Zone III area of penetrating neck trauma
cricoid to skull base
pharynx, cranial nerves, carotids IJV, vetebral arteries
cord
management of penetrating neck trauma
ABCDE inspect and classify manage bleed aerodigestive issues neuro issues FBC, G&S, XM AP/lat neck CXR, CT angio or MRI endoscopy may be considered
when is urgent surgical exploration indicated in penetrating neck trauma
expanding haematoma, shock, obstruction, blood in the aerodigestive tract
cause of deep neck space infection?
tonsil or oropharynx infection
symptoms of deep neck space infection
sore throat febrile limited neck movement red and tender neck trismus
management of deep neck space infection
admit IV access with bloods fluids coamoxiclav and clindamycin theatre to drain manage any airway compromise by securing
management of airway obstruction
ABCDE High flow O2 heliox neb budesonide and adrenaline fibre optic endoscope secure with ET, tracheostomy cricothyroidectomy in emergency cases
features of orbital blowout
pain decreased visual acuity diplopia hypoaesthesia periorbital ecchymosis oedema enophthalmos restricted movemennt bony step
investigation of orbital blowout
CT sinus
surgical if there is eye defect or entrapment
le fort I?
maxilla and upper dentition
le fort II?
maxilla and nose
le fort III?
maxilla, orbit involved
