Traumatic/Mechanical disorders upper airway

Question 1

Epistaxis

Answer 1

Nosebleed

Question 2

Types of epistaxis

Answer 2

Anterior
Posterior

Question 3

Most common form of epistaxis

Answer 3

Anterior

Question 4

Which type of epistaxis is associated with atherosclerosis or bleeding disorders?

Answer 4

Posterior

Question 5

Origin of the bleed in anterior epistaxis

Answer 5

Plexus of vessels in the antero-inferior septum
(Kiesselbach’s area)

Question 6

Origin of the bleed in posterior epistaxis

Answer 6

Posterior septum overlying the vomer bone, or laterally on the inferior or middle turbinate.

Question 7

Causes of Epistaxis

Answer 7

Local trauma (e.g. nose blowing and picking)
Drying of the nasal mucosa
Less common: Local infections, foreign bodies,
arteriosclerosis, septal perforation, coagulopathy

Question 8

Particular attention for in epistaxis

Answer 8

Signs of hypovolaemia or haemorrhagic shock
Anticoagulant drug use
Cutaneous signs of a bleeding disorder
Bleeding not stopped by direct pressure
Multiple recurrences, with no clear cause

Question 9

Tissue injury caused by a pressure related
change in body compartment gas volume

Answer 9

Barotrauma

Question 10

Affected organs in barotrauma

Answer 10

Lungs
Ear
Sinuses
GI tract

Question 11

Risk conditions in barotrauma

Answer 11

Those interfering with equilibration of pressure

Question 12

Pathogenesis of barotrauma

Answer 12

Entrapment of air or other gas within
the lungs → Over-inflation of them → Pulmonary
barotrauma

Question 13

Symptoms of barotrauma

Answer 13

Immediate occurrence, after pressure changes
Ear pain
Vertigo
Hearing loss
Sinus pain
Epistaxis
Abdominal pain
Alveolar rupture and pneumothorax → Dyspnoea
and loss of consciousness

Question 14

Tx of barotrauma

Answer 14

Symptomatic treatment and outpatient follow-up
Life threatening conditions: Alveolar or GI rupture

Question 15

Abnormal vital signs →

epistaxis

Answer 15

High flow 100% O2

Question 16

In case of respiratory failure →

epistaxis

Answer 16

Endotracheal intubation

Question 17

Neurologic symptoms →

epistaxis

Answer 17

Recompression chamber

Question 18

Pneumothorax →

epistaxis

Answer 18

Chest decompression with a large bore needle (2nd intercostal space, midclavicular line) & subsequent thoracostomy

Question 19

Blockage of upper airway, occurs when the upper
breathing passages become narrowed or blocked →
Impairment of breathing

Answer 19

Laryngeal/Pharyngeal Obstruction

Question 20

Affected parts in laryngeal obstruction

Answer 20

i. Trachea, ii. Larynx, iii. Pharynx

Question 21

Causes of laryngeal obstruction

Answer 21

Allergic reactions to various agents and substances
Chemical burns and reactions
Epiglottitis
Fire or burns from breathing in smoke
Injury or infections of the upper airways
Peritonsillar or retropharyngeal abscess
Laryngeal cancer

Question 22

Symptoms of laryngeal obstruction

Answer 22

Agitation or fidgeting
Cyanosis
Changes in consciousness → Unconsciousness
Choking
Confusion and panic
Difficulty in breathing and gasping for air
Unusual breathing noises: Wheezing, crowing, whistling

Question 23

TX of laryngeal obstruction

Answer 23

Removal of stacked objects with special instruments
Insertion of a tube into the airway (endotracheal tube)
Tracheostomy or cricothyrotomy