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ENT > week 2 ENT trauma > Flashcards

week 2 ENT trauma Flashcards

1
Q

how to take Hx of nasal trauma

A 
Mechanism of injury [Fight, sport, fall...]
When
LOC (loss of consciousness )
Epistaxis
Breathing
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2
Q

how to examine nasal trauma

A 
Bruising
Swelling
Tenderness
Deviation
Epistaxis

Facial tenderness
Infraorbital sensation
CNs(extra-ocular exam)
(look from behind to examine)

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3
Q

when to involve specialist with nasal trauma case

A

septal haematoma (rare) - reduced blood supply leading to abscess then get necrosis

profuse epistaxis

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4
Q

how to diagnose nasal #

A

clinical diagnosis (investigations superfluous)

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5
Q

how to treat nasal #

A

Based on deviation/cosmesis

make sure Breathing is okay

Review in ENT clinic 5-7 days post-injury - can then Manipulate under anaesthetic (MUA) or not intervene

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6
Q

complications of nasal #

A

Epistaxis – particularly ant ethmoid

CSF leak can lead to meningitis

Anosmia – cribriform plate fracture

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7
Q

where are the two common areas for nose bleeds to arise from in the nose?

A

little’s area (arteries and front)

venous plexus (at back)

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8
Q

why is epistaxis so common?

A

Vascular organ secondary to incredible heating/humidification requirements

Vasculature runs just under mucosa (not squamous)

Arterial to venous anastamoses

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9
Q

what arteries supply the nose

A

Sphenopalatine A
Ethmoid A
Greater Palatine A

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10
Q

management of epistaxis

A

Resuscitate on arrival if necessary

squeeze lower part of nose, sit forwards

Arrest/slow flow: pressure, ice, topical vasoconstrictor +/- LA (Lignocaine + adrenaline, Co-phenylcaine)

Remove clot: suction, nose blowing

Anterior Rhinoscopy

Cautery / pack (rapid rhino packs)

300 rigid nasendoscopy

Cauterise vessel: silver nitrate / diathermy

Bleeding controlled
Arrange admission if packed/poor social circumstances
FBC, G&S
Please don’t consider sedation!!!

Consider arterial ligation (particularly for AEA bleed)

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11
Q

management of nasal trauma complications (of CSF leak)

A

CSF leaks – often settle spontaneously – need repair if not within 10 days.

Site of fracture may be cribriform plate

Role of antibiotics not clear – ascending infection

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12
Q

what ear trauma can occur

A

Pinna Haematoma

Ear Lacreations

Temporal bone fractures

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13
Q

what is Pinna Haematoma? why does it occur

A

cauliflower ear.

due to blood clot or [other collection of fluid] under the perichondrium, lifts it up and less cartilage.

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14
Q

treatment of Pinna Haematoma

A

excise and drain, then suture

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15
Q

why do lacerations of the ear occur?

A

Blunt trauma

Avulsion

Dog bites

Tissue loss

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16
Q

management of ear laceration

A

Debridement, put ear back in right place, suture (wrap in tissue in ice if complete detachment)

Under LA
then give Antibiotics if cartilage exposed

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17
Q

temporal bone # PC

A 
Injury mechanism
Hearing loss
Facial palsy
Vertigo
CSF leak

Associated injuries (often occurs with many severe injuries = polytrauma EG: assault, RTA…)

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18
Q

examination of temporal bone #

A

Bruising – Battle sign (around back of ear), [+racoon eyes]

Condition of Tympanic Membrane and ear canal

CNVII test (facial palsy)

Hearing test

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19
Q

what are the two types of temporal bone #? which is better?

A

longitudinal/otic capsule sparing - better

transverse/otic capsule involved - worse

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20
Q

things associated with transverse temporal bone #

A

20% of #s
Frontal blows
Fracture at right angles to the long axis of the petrous pyramid
Can cross the internal acoustic meatus causing damage to auditory and facial nerves
Sensorineural hearing loss due to damage to 8th cranial nerve
Facial nerve palsy (50%)
Vertigo

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21
Q

things associated with longitudinal temporal bone #

A

80% of #
Lateral blows
Fracture line parallels the long axis of the petrous pyramid
Bleeding from external canal due to laceration of skin and ear drum
Haemotympanum (conductive deafness)
Ossicular chain disruption (conductive deafness)
Facial palsy (20%)
CSF otorrhoea

22
Q

management of temporal bone #

A

Often delayed as polytrauma

May need facial nerve decompression
If no recovery and EMG studies

May need to manage CSF leak
Most settle but may need repair

May need hearing restoration
Either hearing aid or ossiculoplasty

23
Q

what are the types of hearing loss

A

Conductive
Sensorineural
Mixed
Central

24
Q

causes of conductive hearing loss

A

fluid (blood, effusion, CSF),

tympanic membrane perforation (trauma or chronic)

Ossicular problem (trauma, erosion)

Stapes Fixation - Otosclerosis

25
Q

causes of sensorineural hearing loss

A

Sensory – cochlea

Neural – 8th cranial nerve

26
Q

what two types of neck trauma are there?

A

penetrating (knife, gun, MVA, self-harm, industrial/household incidents)

blunt (MVA, sports injuries[clothesline tackle])

27
Q

who does penetrating neck trauma occur in? mortality

A

young, male, glasgow.

2-6%

28
Q

what is the worst zone to be affected in penetrating neck trauma ?

A

zone 1, then 3, then 2

29
Q

what does zone 1 of neck contain? (lower neck )

A 
Trachea
Oesophagus
Thoracic duct
Thyroid
Vessels – brachiocephalic, subclavian, common carotid, thyrocervical trunk
Spinal cord
30
Q

what does zone 2 of the neck contain (middle neck)

A 
Larynx
Hypoharynx
CN 10,11,12
Vessels – carotids, internal jugular
Spinal Cord
31
Q

what does zone 3 of the neck contain (upper neck, = base of skull + jaw )

A

Pharynx
Cranial Nerves
Vessels – Carotids, IJV, Vertebral
Spinal Cord

32
Q

Hx of neck trauma

A

Mechanism of injury

Pain - location, nature, intensity, onset, radiation

Aerodigestive tract - dyspnoea, hoarseness, dysphonia, dysphagia - haemoptysis

CNS problems - paraesthesias, weakness

33
Q

examination of neck trauma

A 
A – airway	(stridor, hoarseness)
B – breathing	(RR, accessory muscles)
C – circulation (BP, HR, palpable pulse)
D – disability
E – full exposure

Secondary survey [through platysma?, zone of neck, bleeding/haematoma, Aerodigestive injuries, Neurological – power, sensation upper arm]

34
Q

what to do initially with PC of penetrating neck trauma

A

Hx - where possible

Exam - ABCDE

secondary survey - [through platysma?, zone of neck, bleeding/haematoma, Aerodigestive injuries, Neurological – power, sensation upper arm]

35
Q

what to look for in secondary survey of the neck after ABCDE of neck trauma is done?

A

through platysma?, zone of neck, bleeding/haematoma, Aerodigestive injuries, Neurological – power, sensation upper arm

36
Q

what defines a penetrating neck injury vs a superficial?

A

through platysma = penetrating.

37
Q

how to treat superficial neck trauma injury?

A

wash out and close up

38
Q

how to investigate neck trauma

A

FBC, G&S / XM
AP/Lateral neck - ?FB
CXR – haemo-pneumothorax, emphysema

CT Angiogram – vascular, pseudoaneurysm, laryngeal, aerodigestive tract
MRA

39
Q

management of penetrating neck trauma

A

Urgent exploration – expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract (spitting blood bad)

Laryngoscopy, bronchoscopy, pharyngoscopy, and oesophagoscopy

Angiography – embolize, occlude

surgery if object imbedded

MDT approach!!!

40
Q

what can occur due to facial trauma? what type of injury is needed

A

orbital #/injury

le fort #

high energy, disfigurement may be problem

41
Q

what is the Second commonest midfacial fracture

A

orbital floor # (AKA blowout)

42
Q

what causes impact injury to globe?

A

Large enough object not to penetrate globe

Small enough object not to fracture orbital rim

43
Q

Hx and examination of suspected orbital floor #

A

Pain
Decreased visual acuity
Diplopia
Hypoaesthesia in infraorbital region

Periorbital ecchymosis
Oedema
Enopthalmos
Restriction of ocular movement
Bony step of orbital rim

Opthalmic examination

44
Q

investigations of orbital blowout #. what is usually injured in this #

A

CT Sinuses
‘tear drop’ sign

Blow out fracture – medial wall and floor

45
Q

management of orbital blowout #

A

Conservative

Surgical repair of bony walls if:

  • Entrapment
  • Large defect
  • Significant enophthlamos
46
Q

what is a Le fort # 1

A

Horizontal. Passes horizontally above teeth apices

47
Q

what is a Le fort # 2

A

Pyramidal. Nasal bridge, through frontal processes of maxilla, through lacrimal bone and inferior orbital floor, then through under the zygoma, across the pterygomaxillary fissure, and through the pterygoid plates.

48
Q

what is a Le fort # 3

A

Transverse. Craniofacial dysjunctions.

49
Q

Hx and examination of le fort #

A 
Mechanism of injury
LOC & confusion
Airway
Vision
Cranial nerves
Dental Occlusion
Soft tissue swelling
Bruising & haematoma
Posterior retrusion of the mid face
Upper airway may be compromised
Palpate  - detect for bony irregularities, step-offs, crepitus, and sensory disturbances
50
Q

how to investigate le fort #

A

XR – C-spine, Waters view

CT = image of choice

51
Q

management of le fort #

A

surgery - reduce # and fix

maxillofacial - along vertical and horizontal buttresses

52
Q

clinically what can occur with le fort 2 #, 3#?

A

airway obstruction

will be literally holding patients mid-face forward (to allow ventilation)

ENT (19 decks)

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