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ENT week 2 lectures > Trauma/Airway obstruction > Flashcards

Trauma/Airway obstruction Flashcards

1
Q

why can it be fatal if a newborn gets a blocked nose?

A

they are obligate nasal breathers, they cannot breathe through their mouth

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2
Q

what features of a new borns anatomy makes them more at risk of airway obstruction?

A
  • large heads, small nasal openings
  • nasal breathers
  • relatively large tongue
  • small, soft larynx
  • weak neck muscles, floppy head
  • narrow subglottis
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3
Q

how narrow is a neonates subglottis at the cricoid?

A

3.5mm

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4
Q

signs and symptoms of airway obstruction?

A
  • SOB
  • coughing
  • choking
  • stridor/stertor
  • sternal/subcostal recession
  • tracheal tug
  • palor
  • dysphagia
  • dysphonia
  • cyanosis
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5
Q

what is stridor?

A

high pitched harsh noise due to turbulent airflow resulting from airway obstructions

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6
Q

what is stertor?

A

low pitched sonorous sound arising from nasopharyngeal airway (snoring)

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7
Q

what is the problem with adenoid-tonsillar hypertrophy?

A

can cause airway obstruction

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8
Q

what causes recurrent respiratory papillomatosis?

A

HPV infection

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9
Q

where is recurrent respiratory papillomatosis seen?

A

on vocal cords

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10
Q

most common cause of adult subglottic stenosis?

A

vasculitis

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11
Q

should a tracheostomy be perfomed in a child or baby?

A

no, avoided at all possibilities

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12
Q

what are the important things to ask in a history of nasal trauma?

A
  • mechanism of injury
  • when
  • loss of consciousness
  • epistaxis
  • breathing
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13
Q

why do young children not tend to break their noses?

A

as it is all cartilage

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14
Q

when does the nasal cartilage begin to ossify in children?

A

8/9/10 years old

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15
Q

what nerve can be damaged in a nasal trauma that can cause unilateral numbness of the nose and cheek?

A

infraorbital nerve

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16
Q

what problem should be excluded in a nasal trauma?

A

septal haematoma

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17
Q

why is it important to recognise and treat a septal haematoma fast?

A

it can cut off the blood supply to the cartilage and cause necrosis

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18
Q

how is a septal haematoma managed?

A

excised and the layers are stitched back together again

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19
Q

how is a nasal fracture diagnosed?

A

clinically

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20
Q

when is a nasal fracture reviewed in the ENT clinic after the injury?

A

5-7 days post-injury

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21
Q

why must you wait 5-7 days to see ENT after a nasal fracture?

A

so it can be assessed without all the swelling

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22
Q

managment of nasal fracture?

A

either no intervention or may have to put back into place

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23
Q

complications of a nasal fracture?

A

epistaxis, CSF leak, meningitis, loss of smell due to cribriform plate fracture

24
Q

if a nosebleed does not stop in 15-20 mins, what should be given?

A

vasospasms

25
Q

how long can a rapid rhino pack stay in for?

A

a day or two

26
Q

why should sedation not be considered in nose bleeds?

A

airway will be compromised and they can aspirate blood

27
Q

CSF leaks often settle spontaneously but after how many days do they need repaired?

A

within 10 days

28
Q

what can happen if a pinna haematoma isnt treated?

A

AVN of the cartilage of the pinna, becomes deformed

29
Q

managment of a sub-perichondrial haematoma?

A

aspirate or incision and drainage and a pressure dressing

30
Q

what is battle sign?

A

bruising behind the ear

31
Q

what else should you examine in a temporal bone fracture?

A

ear, TM and ear canal

32
Q

what nerve is likely to be damaged in a fracture of the temporal bone?

A

CN VII

33
Q

2 classifications of a temporal bone fracture?

A

-otic capsule involved
-optic capsule spared
or longitudinal or transverse

34
Q

what makes up the otic capsule?

A

labyrinth, inner ear and facial nerve

35
Q

what % of temporal bone fractures are longitudinal fractures?

A

80%

36
Q

what direction does the blow come from in a longitudinal temporal bone fracture?

A

laterally

37
Q

what causes conductive deafness in a longitundinal fracture?

A

blood in tympanic cavity and ossicular chain disruption

38
Q

what direction does the blow come from in a transverse fracture?

A

frontal

39
Q

where is the fracture in a transverse fracture?

A

at right angles to the long axis of the petrous pyramid

40
Q

where is the fracture in a longitudinal fracture?

A

fracture line parallels the long axis of the petrous pyramid

41
Q

what does a transverse fracture damage if it crosses the internal acoustic meatus?

A

auditory and facial nerves

42
Q

why is there sensorineural HL in a transverse fracture?

A

damage to the 8th cranial nerve

43
Q

what % of patients get facial nerve palsy in a transverse fracture?

A

50%

44
Q

causes of conductive hearing loss?

A
  • fluid - effusion, blood, CSF
  • TM perforation
  • ossicular disruption/fixation
  • stapes fixation - otosclerosis
45
Q

what structures are in Zone I in the neck trauma classification?

A

trachea, oesophagus, thoracic duct, thyroid, vessels, spinal cord

46
Q

what vessels are in zone I?

A

brachiocephalic, subclavian, common carotid, thyrocervical trunk

47
Q

what structures are in Zone II in neck trauma?

A

larynx, hypopharynx, CN 10,11,12, carotids, internal jugular, spinal cord

48
Q

what structures are in zone III in neck trauma?

A

pharynx, cranial nerves, carotids, IJV, vertebral artery, spinal cord

49
Q

what is the most common zone for injuries and least likely to cause catastrophic injuries?

A

zone II

50
Q

when is an injury classed as a penetrating neck injury?

A

when it goes through the platysma

51
Q

what is the platysma?

A

a muscle of the neck that goes all the way round the neck

52
Q

what type of force causes maxillary fractures?

A

a high-energy blunt force injury to facial skeleton

53
Q

what is the second most common midfacial fracture?

A

orbital floor fractures

54
Q

where do most fractures of the orbital floor occur? and why?

A

posterior medial region, compromised of the thinnest bones

55
Q

what does the ‘tear drop’ sign on CT suggest?

A

a blow out fracture - medial wall and floor

ENT week 2 lectures (5 decks)

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