TUT - OMFS trauma Flashcards
What is stridor?
Inspiratory noise and sign of airway obstruction
What is wheeze?
Expiratory noise and sign of airway obstruction
What is stertor?
Inspiratory noise and sign of airway obstruction at the top of airway (sounds like snoring)
What is a visual sign of airway obstruction?
- cyanosis
- choking
- red face
What are difficult airways according to ATLS?
- uncleared neck (hard collar)
- poor mouth opening
- intoxicated or reduced GCS
- beards
- overweight
- arthritic necks (silver trauma)
- maxillofacial trauma
What injuries are associated with a risk to the airway?
- bilateral mandible fracture (muscles pull mandible backwards and tongue occludes airway)
- midface or pancake fractures
- neck injuries
What airway manoeuvres are available?
- chin lift
- jaw thrust
- oropharyngeal airway
- nasopharyngeal airway
What contraindicates a chin lift?
- fractured mandible
- fractured neck
What contraindicates a jaw thrust?
If fingers are resting on mobile bones
What contraindicates an oropharyngeal airway?
- reduced mouth opening
- plastic collar
What contraindicates a nasopharyngeal airway?
Fractured midface without scan to guide airway
What are common sites are bleeding emergencies?
- major vessels
- maxilla
- mandible
- nose
What adjuncts can be used to stop bleeding in midface fractures?
- tranexamic acid
- interventional radiology (balloons via veins)
- medication impregnated gauze
- epistat
- reduce fractures to apply pressure (sedation and intubated)
What is orbital compartment syndrome?
- retrobulbar bleeding
- fifteen minutes to blindness
- surgical emergency but not more important than primary ATLS
What is involved in secondary sight assessment?
- pupils (check disability)
- eye movement or paralysis
- pain
- chemises (conjunctiva looks like snot)
- proptosis (sticking out, rock hard)
- visual activity (red colour sight is lost first)
- numbness in surrounding tissue
How do you manage orbital compartment syndrome?
- steroids (although does not replace surgical intervention)
- 999
What are signs of broken bones in the midface?
- numbness
- mobility
- visual changes
- pupils acuity and movement
- symmetry
- CSF
What imaging is required for broken bones?
- 2 plain films
- or CT
- contact OMFS ASAP
What is the core advice for OMFS trauma?
- tetanus
- open fractures require antibiotic cover or fracture through dentate part of mandible
- refer all fractures
- fast until contact with OMFS
- no nose blowing
- teeth can be placed back
- check eyes
What history is important regarding fractures?
- blunt or sharp injury
- when
- any other issues
- drugs/alcohol/smoking (smoking increases complications)
- PMH (relevant anti-coag, diabetes)
- allergies
- social implications
Define a laceration.
Blunt force to soft tissue (burst or contusion around site of injury)
Define an incised wound.
Cut by a sharp object
What are hard signs of mandible fracture?
- 2 point vertical mobility
- sublingual haematoma
- contralateral numbness to side of impact
- ipsilateral numbness is impact was distant to extraosseous mental nerve
What are hard signs of orbital fracture?
- no distinctive signs, presents with multiple signs
- infraorbital paraesthesia
- diplopia
- subconjunctival bleed
What are hard signs of zygoma fracture?
- unilateral epistaxis when nose not injured
- eyebrow sign (gas escapes from sinus to above eye)
- paraesthesia when trauma is distant to extraosseous infraorbital nerve
- buttress/arch/infraorbital/frontal zygomatic suture tenderness when not punched in all areas
What are hard signs of midface fracture?
- mobility of maxilla when skull base stabilised
- often numb
- epistaxis
What is le fort 1?
Palate only
What is le fort 2?
Palate and nose
What is le fort 3?
Palate, nose and orbit
What bone must break in order for it to be considered a le fort fracture?
Pterygoid plate
What are the hard signs of naso-orbito-ethmoidal fracture?
- retropositioned nose
- buttress not tender
- epistaxis
- often numb
- steps at IOR, pyriform, glabella
- hyperteloric (eyes drift apart)
What are the hard signs of nasomaxillary fracture?
- tender IOR and pyriform
- buttress intact
- numb
- unilateral epistaxis without blow to nose
What imaging is required for mandible fracture?
OPT and PA mandible
What imaging is required for zygoma fracture?
2 PA skulls
What imaging is required for orbit fracture?
2 PA skulls
How do you describe a fracture in the premolar region?
Parasymphaseal
How do you describe a fracture in the 7/8 region?
Angle
