ENT emergencies Flashcards
(30 cards)
Management of nasal septal haematomas
Urgently referred to ENT for drainage
Review nasal fracture in ENT clinic 5-7 days post-injury
What is epistaxis?
Nose bleed
What is pinna haematoma?
Common injury following shearing forces applied the auricle, most commonly seen amongst rugby players and boxers “cauliflower ear”
Management of pinna haematoma
Aspiration, incision and drainage, or pressure dressing
How should a live animal lodged in the ear be managed?
drown with oil, can be removed next day
What is the management of foreign bodies in the ear and nose?
Can usually wait until the urgent clinic for removal
Except for watch batteries
=remove immediately**
What is the primary recommendation for preventing the recurrence of epistaxis after initial bleeding has been controlled?
Naseptin
An 18-year-old man presents to the emergency department after sustaining a nasal injury following a car accident. On examination, the nose is swollen with some bruising and suspected nasal deviation to the left. Anterior rhinoscopy shows a bilateral cherry-red swelling arising from the nasal septum
What does this describe?
septal haematoma
What is hereditary haemorrhagic telangiectasia?
Autosomal dominant disorder characterised by telangiectasia on skin and mucous membranes.
These malformations can occur within the nasal mucosa and are prone to bleeding
IIncision with primary closure is used when?
firm haematoma that is more than 7 days old
A 60-year-old man presents to General Practice complaining of recurrent nosebleeds without an obvious trigger. The most recent episode lasted six hours. He has no relevant medical history and takes no regular medications. ENT examination is normal. BP 120/85, HR 100. Bloods are sent for full blood count (FBC) and clotting
What is the most appropriate additional step in management?
Liver disease is a common cause of recurrent epistaxis
= LFT’s
What is the most common site of anterior nosebleeds, and what is the treatment?
Little’s area (Kiesselbach’s plexus)
= pressure or cautery
What is the most common site of Posterior epistaxis, and what is the treatment?
Sphenopalatine artery (deep)
= packing
How to know the patient has thrombocytopenia and what is the treatment?
platelet level is <30 x 10^9/ L
= Transfusion with 1 unit of platelets
The most appropriate management for a patient with nasal trauma who presents with deformity, tenderness over nasal bones, bloody discharge and difficulty in breathing is to obtain what?
Obtain a CT scan of the nasal bones and perform a nasal endoscopy
A 35-year-old male presents to the emergency department with a sore throat, difficulty in swallowing and talking, and a fever. He reports a previous history of tonsillitis. Examination reveals a swollen, deviated uvula, and the soft palate is red and swollen, with an enlarged tonsil on the right side
What is the definitive management for this patient?
Aspiration and drainage if the patient has quinsy, then prescribe intravenous antibiotics
Epistaxis that has failed all emergency management may require what?
sphenopalatine ligation in theatre
What is nasal septal haematoma?
blood collection between the septum and its lining, usually after trauma. It needs urgent drainage to prevent infection or nose deformity
A child or adult with recent nasal trauma
(eg, from a fall, fight, or sports injury)
presenting with nasal obstruction, swelling inside the nose, possibly pain or tenderness, and difficulty breathing through the nose. On examination, there may be a soft, fluctuant swelling on both sides of the septum.
This suggest what?
nasal septal haematoma
What are the nasal septal haematoma buzzwords
- Risk of cartilage necrosis
- Soft boggy swelling on nasal septum
- Bilateral nasal obstruction after trauma
A 12-year-old boy presents to the clinic with a painless, fluctuant midline neck mass that moves upward upon swallowing and with tongue protrusion. The mass is located below the hyoid bone, and it has been present for a few months.
What is the most appropriate management?
Surgical
An 18-year-old man presents to the emergency department after sustaining a nasal injury following a car accident. On examination, the nose is swollen with some bruising and suspected nasal deviation to the left. Anterior rhinoscopy shows a bilateral cherry-red swelling arising from the nasal septum
Which is the most appropriate treatment for this patient?
Emergency incision and drainage
Adenoid cystic carcinoma are malignant tumours of the what?
Parotid gland
A 21-year-old woman presents with recurrent epistaxis. She reports that this is common in her family, with her father and brother also being affected
She denies menorrhagia or any bleeding problems during her previous dental surgery. She has red freckles over her lips
What is the single most likely diagnosis?
Hereditary haemorrhagic telangiectasia
