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otolaryngology > ENT Emergencies > Flashcards

ENT Emergencies Flashcards

(80 cards)

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1
Q

What mechanisms of injury cause nasal trauma

A

Fighting, sports injuries, falls

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2
Q

Important questions to ask a patient with nasal trauma

A

When it occurred
Any loss of consciousness
Nose bleeding
Effect on breathing

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3
Q

Signs of nasal trauma

A

Bruising, swelling
Tenderness
Deviation
Epistaxis

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4
Q

Management of septal haematoma

A

Must be drained to prevent nasal collapse

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5
Q

Consequence of nasal haematoma

A

Stops blood supply getting to the cartilage

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6
Q

What must be ruled out in nasal trauma

A

Septal haematoma

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7
Q

Management of nasal trauma

A

Review in ENT clinic 5-7 days post-injury
Consider manipulation in <3 weeks

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8
Q

What artery is commonly damaged in nasal trauma leading to epistaxis

A

Anterior ethmoid artery

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9
Q

What is epistaxis

A

Nose bleed

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10
Q

Name some local causes of epistaxis

A

Idiopathic, trauma, foreign bodies, inflammation, tumour

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11
Q

Name some systemic causes of epistaxis

A

Drugs, clotting abnormalities, haemophilia, leukaemia, thrombocytopenia

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12
Q

Name some drugs that can cause epistaxis

A

Snorting cocaine
Aspirin, DOACs, warfarin

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13
Q

Commonest site of bleeding in epistaxis

A

Little’s area

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14
Q

What is little’s area

A

Place on the anterior septum where a number of vessels anastomose

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15
Q

What vessels are found in little’s area

A

Anterior ethmoid, posterior ethmoid, sphenopalatine, great palatine, superior labial

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16
Q

MOA of tranexamic acid

A

Inhibits the breakdown of fibrin clots

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17
Q

Systemic management of epistaxis

A

Tranexamic acid, reversal of anticoagulation

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18
Q

First aid management of a nose bleed

A

Squeeze soft part of nostrils together and tilt head forwards
Spit out blood rather than swallowing it

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19
Q

Direct therapy of persistent nose bleeds

A

Silver nitrate cautery if there’s an identifiable anterior bleeding point

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20
Q

Surgical management of epistaxis

A

Endoscopic sphenopalatine artery ligation

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21
Q

Indirect management of epistaxis

A

Nose packs
Foley catheters to compress difficult to identify bleeding points

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22
Q

What causes a CSF leak

A

Fracture through the cribiform plate

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23
Q

What does the cribiform plate form

A

The roof of the nasal cavity

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24
Q

How does a CSF leak present

A

Persistent clear rhinorrhoea
Headache

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25
When does a CSF leak need repairing
If it hasn’t resolved spontaneously within 10 days
26
Why do we not initially give antibiotics to a patient with a CSF leak
Can mask meningitis
27
What is a pinna haematoma caused by
Shearing forces applied to the auricle
28
Who commonly presents with pinna haematoma
Rugby players and boxers
29
What is a complication of an untreated pinna haematoma
Avascular necrosis
30
Pathophysiology of pinna haematoma
Following trauma the perichondrial blood vessel tears, resulting in a haematoma between the auricular cartilage and the overlying perichondrium
31
What is cauliflower ear
Fibrocartilage overgrowth secondary to a pinna haematoma
32
Management of a pinna haematoma
Aspiration, incision and drainage OR pressure dressing
33
What are the 2 main classifications of temporal bone fracture
Longitudinal or transverse
34
What is the most common type of temporal bone fracture
Longitudinal fractures
35
What usually causes a longitudinal temporal bone fracture
A lateral blow to the head
36
What is a longitudinal temporal bone fracture
Fracture line is parallel to the long axis of the petrous pyramid
37
Complications of a longitudinal fracture of the temporal bone
Bleeding from external canal due to laceration of skin and eardrum Hemotympanum Ossicular chain disruption Facial palsy CSF otorrhoea
38
What is hemotympanum
Blood in the middle ear space
39
What causes transverse fractures
Fronto-occipital head trauma
40
What is a transverse temporal bone fracture
Fracture at right angle to the long axis of the petrous pyramid
41
Complications of a transverse temporal bone fracture
Can cross the internal acoustic meatus and cause damage to the auditory and facial nerves Sensorineural hearing loss due to damage of CN8 facial nerve palsy Vertigo
42
Important questions to ask a patient with a temporal bone fracture
Injury mechanism Symptoms: hearing loss, facial palsy (immediate or delayed), CSF leak, vertigo, associated injuries
43
Sign of a temporal bone fracture
Battle sign
44
What is battle sign
Bruising over mastoid, indicates base of skull fracture
45
Investigation for temporal bone fracture
CT
46
Management of temporal bone fracture
Mostly conservative
47
Management of conductive hearing loss following trauma
May need facial nerve decompression May need hearing restoration- hearing aid, ossiculoplasty
48
Management of sudden sensorineural hearing loss following trauma
Weber test, high dose steroids, consider intratympanic treatment
49
Management of foreign bodies in the ear and nose
Can usually wait until clinic for removal
50
What is the exception to waiting to remove foreign bodies in the ear and nose
Watch batteries
51
How do we manage swallowed foreign bodies
Impacted body must be removed
52
Who is more likely to get neck trauma
Young males
53
Causes of penetrating knife trauma
Knife crime Industrial or household accidents
54
Causes of blunt neck trauma
Motor vehicle accident Sporting injuries: clothesline tackle
55
How do we classify neck trauma
Zone 1,2 and 3
56
Contents of zone 1 of the neck
Trachea, oesophagus, thoracic duct, thyroid, vessels, spinal chord
57
Vessels in zone 1 of the neck
Brachiocephalic, subclavian, common carotid, thryocervical trunk
58
Contents of zone 2 of the neck
Larynx, hypopharynx, CN 5,6,7, vessels, spinal chord
59
Vessels in zone 2 of the neck
Carotids, internal jugular
60
Contents of zone 3 of the neck
Pharynx, cranial nerves, vessels, spinal chord
61
Vessels in zone 3 of the neck
Carotid, internal jugular vein, vertebral
62
ABCDE signs of neck trauma
Stridor, hoarseness, use of accessory muscles
63
Investigations in neck trauma
x-rays, CT angiogram, MRI, laryngoscopy, bronchoscopy, oesophagoscopy
64
What is a deep neck space infection
Extension of infection from tonsil or oropharynx into deeper tissues
65
Symptoms of a deep neck space infection
Sore throat, generally unwell, limited neck movement
66
Signs of a deep neck space infection
Febrile, trismus, red/tender neck
67
What is another name for trismus
Lockjaw
68
Management of a deep neck space infection
Rehydration IV antibiotics Incision and drainage of big abscesses
69
IV antibiotics used to manage deep neck space infections
Co-amoxiclav or clindamycin
70
Complication of deep neck space infection
May extend into mediastinum through fascial compartments
71
What makes the larynx of a neonate different
Obligate nasal breathers Large tongues Small, soft larynx Narrow subglottis
72
Symptoms of airway obstruction
SOB on exertion or at rest Choking Coughing Inability to complete a sentence
73
Signs of airway obstruction
Sternal/subcostal recession Tracheal tug Pyrexia Cyanosis Stridor/stertor
74
What is another name for stertor
Snoring
75
What is the last option management of airway obstruction
Tracheostomy
76
Name some causes of ear lacerations
Blunt trauma Avulsion Dog bites
77
Management of ear lacerations
Debridement, closure Usually under local
78
Complication of ear laceration
Tissue loss
79
Usual mechanism of injury for maxillary fractures
High energy blunt force trauma to the facial skeleton
80
Clinical presentation of orbital floor fractures
Bruising around the eye, eyes look sunken in, restriction of ocular movement, swelling

otolaryngology (18 decks)

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