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Y2 ENT > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

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1
Q

What is important to check when a patient presents with nasal trauma

A

Deviation
Epistaxis
Nasal septum
Breathing

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2
Q

What are the complications of nasal trauma

A

CSF leak
Septal haematoma -> necrosis of cartilage
Epistaxis
Anosmia (loss of smell)

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3
Q

Why is it important to check the nasal septum when a patient presents with nasal trauma

A

To check for septal haematoma

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4
Q

What is septal haematoma

A

Bleeding under the perichondrium lining the septal cartilage, commonly caused by nasal trauma

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5
Q

Why is septal haematoma problematic

A

It stops blood supply getting to the septal cartilage since the cartilage gets its blood supply from the mucosa (the haematoma separates the mucosa and cartilage)

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6
Q

What can occur if septal haematoma is not treated early enough

A

septal perforation and necrosis
resulting in saddle-nose deformity

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7
Q

Management of septal haematoma

A

Urgent referral to ENT
Emergency incision & drainage

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8
Q

Management of suspected nasal fracture

A

Review nasal fracture in ENT clinic 5-7 days post-injury (if seen too early, it may not be visible)
Consider closed reduction if needed

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9
Q

Management for ear lacerations

A

Debridement
Closure under local anaesthetic
Cover with antibiotics if cartilage is exposed

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10
Q

What is CSF leak

A

Cerebral spinal fluid from the brain leaks through the cribriform plate and out of the nose

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11
Q

Symptoms of CSF leak

A

Headache
Persistent clear rhinorrhea

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12
Q

Management of CSF leak

A

Often settles spontaneously
Repair if does not resolve within 10 days
Do not give antibiotics initially

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13
Q

Causes of epistaxis

A

Idiopathic
Trauma
Foreign bodies
Tumour
Alcohol
Drugs (warfarin, aspirin, antiplatelets..etc)
Coagulopathy
Leukaemia
Thrombocytopaenia
Hereditary hemorrhagic telangiectasia
GPA

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14
Q

What drugs can cause epistaxis

A

Antiplatelets (clopidogrel, ticagrelor..etc)
Anticoagulants (warfarin, heparin, apixaban..etc)
Aspirin (both a NSAID and anti platelet)
NSAID

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15
Q

Examples of antiplatelets

A

Clopidogrel
Prasugrel
Ticagrelor

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16
Q

Examples of anticoagulants

A

Warfarin
Heparin
Apixaban
Rivaroxaban
Dabigatran

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17
Q

Apixaban, rivaroxaban and dabigatran are

A

DOAC - direct oral anticoagulants

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18
Q

Which has a higher bleeding risk - warfarin or DOAC

A

Warfarin

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19
Q

If a patient with epistaxis has hypertension, they are likely to

A

have prolonged bleeding

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20
Q

Where is the most common site of epistaxis

A

Kiesselbach’s plexus - at anterior septum

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21
Q

What are the arteries that contribute to the Kiesselbach’s plexus

A

anterior ethmoid
posterior ethmoid
sphenopalatine
great palatine
septal branch of superior labial

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22
Q

Sphenopalatine artery is a branch of

A

Maxillary artery

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23
Q

Greater palatine artery is a branch of

A

Maxillary artery (descending palatine branch)

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24
Q

Maxillary artery is a branch of

A

External carotid artery

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25
Superior labial artery is a branch of
Facial artery
26
Facial artery is a branch of
External carotid artery
27
Anterior and posterior ethmoidal arteries are branches of
Ophthalmic artery
28
Ophthalmic artery is a branch of
Internal carotid artery
29
Name A-E
A- Anterior ethmoidal artery B- Posterior ethmoidal artery C- Septal branch of superior labial artery D- Sphenopalatine artery E- Greater palatine artery
30
Anterior bleeding of the nose is usually due to rupture of which vessels and what usually causes it
Anterior and posterior ethmoid arteries mostly due to trauma
31
Posterior bleeding of the nose is usually due to rupture of which vessel and what usually causes it
Sphenopalatine arteries Mostly due to underlying pathologies such as hypertension
32
Management of epistaxis
Take a brief history - ask about anticoagulants/antiplatelets 1. Direct compression of the cartilaginous part of nose, patient leaning forward, spitting out into a bowl, ice pack 2. Silver nitrate nasal cautery if there is a visible anterior bleeding point 3. Nasal packs or Foley catheters if bleeding point difficult to identify (posterior bleeding / heavy bleeding ) 4. Sphenopalatine artery ligation for posterior bleeds
33
Why do patients with epistaxis need to pinch their nose while leaning forward
To prevent blood from entering the oral cavity / pharynx Swallowing blood can cause vomiting and stomach irritation
34
When is nasal packing used for epistaxis
If it is posterior bleeding which is hard to identify Heavy bleeding
35
When is sphenopalatine artery ligation indicated
Posterior bleeding Uncontrollable severe bleeding
36
What is pinna haematoma
Perichondrial blood vessels tear due to trauma resulting in bleeding between the auricular cartilage and overlying perichondrium
37
Injury mechanicm of pinna haematoma
Shearing type injuries to the auricle e.g. in rugby players and boxers
38
What can pinna haematoma lead to
Disrupt blood supply to the cartilage -> avascular necrosis of pinna -> Cauliflower deformity of the ear
39
Appearance of pinna haematoma
40
Management of pinna haematoma
Urgent aspiration, drainage, decompression of the haematoma within 24 hours of injury
41
Which bone of the base of the skull is the most commonly fractured
Temporal bone
42
Types of temporal bone fracture
Longitudinal Transverse
43
The classification of longitudinal / transverse depends on
the relation of the fracture with the axis of the ear canal
44
Which type of temporal bone fracture is the most common
Longitudinal fracture
45
Injury mechanism of longitudinal fracture
Lateral blow to the head
46
Symptoms of basal skull fracture
Reduced consciousness Battle's sign - bruising of the mastoid CSF leak Epistaxis / bleeding from ear Haemotympanum Facial nerve palsy
47
What is Battle's sign
Bruising over the mastoid process, indicating base of skull fracture
48
What is haemotympanum
Blood behind the tympanic membrane
49
Investigations for basal skull fracture
CT Hearing test, facial nerve examination
50
Complications of longitudinal temporal bone fracture
Haemotympanum -> Conductive hearing loss Disruption of ossicles -> conductive hearing loss Facial palsy CSF otorrhea (leak from ear)
51
Complications of transverse temporal bone fracture
Can cross the internal acoustic meatus and damage auditory and facial nerves Sensorineural hearing loss Facial palsy Vertigo
52
Which type of temporal bone fracture more commonly presents with facial nerve palsy
Transverse fracture
53
For neck trauma, the neck is divided into
3 zones
54
What are the borders of zone 1 for neck trauma
From the sternal notch -> cricoid process
55
What structures are at risk of being damaged at zone 1
Trachea Recurrent laryngeal and vagus nerves Oesophagus Subclavian artery and vein Brachiocephalic vein Proximal part of common carotid artery Jugular veins Spinal cord
56
What are the borders of zone 2 for neck trauma
Cricoid process -> angle of mandible
57
What structures are at risk of damage in zone 2
Larynx Pharynx Vagus nerve Distal part of common carotid artery Proximal part of internal and external carotid arteries Jugular veins Spinal cord
58
What are the borders of zone 3 of neck trauma
Angle of mandible -> base of skull
59
What structures are at risk of damage in zone 3
internal and external carotid arteries Jugular veins Cranial nerves IX - XII Spinal cord
60
Investigations for neck injury
Ask mechanism of injury Assess if there is any CNS problems ABCDE Haemodynamically stable ?
61
Management for patients with neck injury that are haemodynamically stable
CT angiogram -> surgical exploration / angiography / oesophagram / endoscopy / laryngoscopy
62
Management for patients with neck injury that are not haemodynamically stable
immediate surgery
63
What are deep neck space infections
When infections from the oropharyngeal region spreads into fascial planes
64
What are the 2 types of deep neck space infections
Parapharyngeal abscess Retropharyngeal abscess
65
What is parapharyngeal abscess
When infection spreads to the space posterolateral to nasopharynx
66
What is retropharyngeal abscess
When infection spreads to the space anterior to pre vertebral fascia
67
Symptoms of deep neck space infections
Severe sore throat Unwell Neck stiffness Trismus Voice changes Fever
68
What are the red flag symptoms for suspected DNSI patients that may indicate they can quickly decompensated
Severe neck pain or stiffness Airway compromised - stridor/ drooling/ dyspnoea
69
Investigations for DNSI
Bloods - extremely high inflammatory markers CT with IV contrast
70
Management for DNSI
IV antibiotics (broad spectrum) - co-amoxiclav/clindamycin IV fluid resuscitation Oxygen / intubation Surgical drainage
71
What antibiotics are used for DNSI
Co-amoxiclav or clindamycin

Y2 ENT (7 decks)

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