ENT emergencies Flashcards Preview

ENT > ENT emergencies > Flashcards

Flashcards in ENT emergencies Deck (39)
Loading flashcards...
1

Trauma:
-what is the primary concern in facial, head, or neck trauma?

-main concern is maintaining the airway. --avoid nasal tracheal intubation, consider Endotracheal intubation, laryngeal mask airway, cricothyroidotomy

2

Why is it important to avoid NG tubes or any tube in the nose until the extent of head, facial, or neck truma is determined?

may have facial fxs that lead to NG tube placement in the brain.

3

PE findings that will hlep reveal 90% of ENT fx:
-nose
-ears
-oral and mandibular

Nose:
-csf rhinorrhea
-septal hematoma
-nasal fx

Ears:
-subperichondral (auricular) hematoma
-hemotympanum
-battle sign

Oral and Mandibular:
-mandibular deviation
-malocclusion of teeth paresthesia
-tongue blade test

4

How do we determine CSF Rhinorrhea on PE?

What is the significance of CSF rhinorrhea?

-halo sign; drop of blood on linen and see dark circle of blood with light halo ring surrounding it. This means there is CSF in the blood.

significance: direct communication with the CNS exists d/t disruption of the bony barrier and tear in the dura, significant risk for CNS infection

5

How do you differentiate between clear nasal discharge and CSF?

clinical hx

filter paper and look for halo sign

test for glucose with glucose oxidase paper

6

Septal Hematoma:
-cause?
-tx
-what type of fx many result in formation of bilateral hematomas?

cause:
-trauma to anterior nasal septum in adults
-simple falls or minor altercations in children

Tx:
-drain and pack
-abx (augmentin...if abscess suspected IV clindamycin and admit to hospital)

Cartilage fx may result in formation of bilateral hematoma.

7

Complications from not drainingn a septal hematoma?

-saddle nose deformity
-septal perforation
-septal abscess

8

What is the most commonly fx bone in the face?

nose!! :)

9

Nasal fx
-dx
-sx
-PE
-tx

dx: based upon PE.

Sx: edematous and tender

PE: look for displacment, crepitus, and epistaxis

Tx: manage 2-10days post injury to allow for reduction of swelling.
-if significant displacement of nasal fx on films need ENT consult.

10

Auricular hematoma
-cause
-tx

cause: direct trauma to auricle, caused by separation of the cartilage from the perichondrium resulting in avascular necrosis

Tx: drain within 7days, compression dressing, daily follow up for a few days, abx to cover staph.

11

Cauliflower Ear
-cause

Ear laceration
-tx

Causes: failure to drain hematoma
-stimulation of cartilage growth
-laceration through cartilage
-infection
-high piercings

Ear Laceration:
Tx: can do single layer closure through skin and perichondrium but not the cartilage.
-pressure to dressing to prevent hematoma
-close follow up
-can use posterior auricular block for anesthesia

12

What are some findings of middle ear injury?

-hemotympanum
-amber/clear middle ear effusion
-otorrhea
-hearing deficit by weber and rinne tuning fork tests
-nystagmus
-ataxia
-retroauricular hematoma (battle sign)
-facial nerve deficit may be a sign of basilar skull fx or associated with a middle ear injury

13

Basilar Skull Fx
-fx of what bones?
-what three signs are most evident?

fx in the temporal, occipital, sphenoid, and ethmoid bones

-battle sing (6-12hrs), hemotympanum, raccoon eyes

14

ottorhea:
-must evaluate for?
-what do you do if penetrating FB?

must evaluate for blood or CSF

if penetrating FB leave the FB there until further evaluation with imaging.

15

Mandibular fx:
-dx
-tx

Dx:
-tongue blade test: bite down and twist, if mandibular fx cannot do this.
-XRAY or CT


Tx:
-airway management, hemostasis, and surgery consult.

16

Blunt trauma to neck
-first thing you need to do when this pt comes in?
-MC cauase

first thing you need to do is determine if the airway and patient are stable or unstable, pt may deteriorate rapidly..impending airway obstruction

MC Cause: MVA

17

Laryngeal trauma management

-follow ATLS principles
- tracheostomy in pts exhibity resp distress, call ENT or surgeon.
-those w/ no acute breathing difficulties get a hx, PE, and serial flexible fiberoptic exams to differentiate the need for medical/surgical management.

18

Nasal FB
-sx
-dx
-tx
-typical pt

sx: unilateral rhinitis, foul odor, epistaxis, pain

dx: direct vizualization or Xray

Tx: remove w/ forceps or suction

Patient: toddler with unilateral foul smelling nasal discharge.

19

Epistaxis
-MC site of bleeding
-why are psoterior bleeds more severe?
0

MC site is Kiesselbachs plexus

Posterior more severe and harder to treat d/t arterial involvement (sphenopalatine artery)

20

Causes of Epistaxis
-local
-systemic

Local: trauma, epistaxis digitorum*, FB, medications, vascular malformation, chronic sinusitis, neoplasms, polyps, irritants.

Systemic:
-hemophilia, HTN, leukemia, liver dz, anticoagulants*, blood dyscrasias

21

Management of Epistaxis

blow nose to clear clots

spray with topical vasoconstrictor (afrin)

lean forward and pinch nares together for at least 20minutes continuously

examine and locate site of bleeding.

**This works for anterior epistaxis only, posterior nose bleed requires more invasive procedure.

May require silver nitrate cautery, if cautery is unsuccessful use nasal tampon or packing. Leave in place for 48hrs, follow up in 24-48hrs.

22

WHat are some risks to nasal packing?

WHo performs posterior packing?

-if packing is too tight necrosis may occur. Toxic shockk syndrome.

Not you, you call the ENT. most of these patients are admitted to the hospital

23

Auricular cellulitis
-MC cause
-population at high risk
-

MC cause: Staph aureus and pseudomonas

Population at high risk - DM, difficult to tx d/t poor blood supply

24

Barotrauma
-etiologies
-tx

Etiologies:
-flying
-diving
-blast injuries


Tx:
-supportive
-keep ear dry
-recheck in 4weeks to determine if TM is healed
-audiometry evaluation

25

TM rupture
-if what sx are associated an immediate referral is indicated?

-MC cause

-tx

-if vertigo or facial nerve deficit an immediate referral is indicated.

MC cause: infection

Tx:
-keep ear dry
-most heal spontaneously
-abx drops; ofloxacin for 3-4days, PO abx may be indicated as well

26

Epiglotitis
-presentation
-evaluation
-tx
-etiology

Presentation:
-drooling, fever, hoarseness, diff swallowing, stridor

Eval: dx is clinical, lateral neck Xray

Tx:
-emergent ENT referral where they will get IV abx and possible intubation

Etiology:
-h flu
-strep neumo
-staph aureus
-M. cat

27

Peritonsillar abscess
-aka
-complication of what?
-presentation
-management

aka: quincy

complication of tonsillitis

presentation: severe unilateral throat pain, fever, difficulty swallow, hot potato voice, halitosis, neck pain, ear pain on affected side, HA, trismus

-managment:
-dx is mainly clinical
-supportive therapy; airway, fever, pain, and hydration
-need immediate ENT referral for I&D and IV abx

28

Retropharyngeal abscess
-what and where
-complications
-causes in children
-causes in adults

What
-deep tissue neck infection
-more of a cellulitis than an abscess

Where
-retropharyngeal space extends from the base of the skull to the tracheal bifurcation

Complications
-asphyxia
-spread of infection
-asp pneumonia
-pleural or peridcardial effusion


Causes in children
-usually from lymph node that drains head and neck

Causes in adults
-Penetrating trauma
-mouth/teeth infection
-lymph nodes that drain head and neck

29

Retropharyngeal abscess signs and sx

fever

dysphagia

neck pain

limited cervical ROM

cervical lymphadenopathy

sore throat

poor oral intake

muffled voice

resp distress

stridor in children

inflamm torticollis

30

Retropharyngeal abscess
-work up
-tx

WOrk up:
-lateral Xray of neck during inspiration

-CT of neck is GOLD standard

Tx: immediate ENT consult
-I&D
-IV hydration and abx (clindamycin or Unasyn)