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ENT Emergencies Flashcards

(106 cards)

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1
Q

What is the primary concern in facial, head, or neck trauma?

A

Airway

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2
Q

Avoid ________ tracheal intubation

A

Nasal

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3
Q

Besides epistaxis, what is the best way to control hemorrhage control?

A

Direct pressure

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4
Q

What is the significance of CSF rhinorrhea?

A

Direct communication with the CNS due to disruption of the bony barrier and a tear in the dura

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5
Q

How do you distinguish nasal discharge from CSF?

A

Look for “halo” sign

Test glucose

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6
Q

Septal Hematomas in Adults Occur From?

A

Significant trauma

Nasal fracture

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7
Q

Septal Hematomas in Children Occur From?

A

Simple falls

Minor altercations

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8
Q

Treatment of Septal Hematomas

A

Drain & pack

Antibiotics

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9
Q

Which antibiotic do you use for the treatment of a septal hematoma?

A

Augmentin

If abscess- Clindamycin & admit

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10
Q

What condition can result in bilateral hematomas?

A

Cartilage fracture

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11
Q

Complications if a septal hematoma is not drained

A

Saddle-nose deformity
Septal perforation
Septal abscess

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12
Q

Septal abscess may spread to:

A

Paranasal & intracranial structures

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13
Q

What is the most common fracture within the head?

A

Nasal Fracture

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14
Q

Signs & Symptoms for Nasal Fracture

A 
Edematous
Tender
Displacement
Crepitus
Epistaxis
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15
Q

What is the time frame to perform a closed reduction for a nasal fracture?

A

2-10 days

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16
Q

What causes an auricular hematoma?

A

Direct trauma to the auricle

Separation of cartilage from perichondrium

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17
Q

Treatment for Auricular Hematoma

A

Drain

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18
Q

What happens when an auricular hematoma doesn’t get drained?

A

Cauliflower Ear

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19
Q

Causes of Cauliflower Ear

A 
Failure to drain hematoma
Simulation of cartilage growth
Laceration through cartilage
Infection
High piercings
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20
Q

How can you prevent cauliflower ear?

A

Protective head gear

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21
Q

What is the management of an ear laceration?

A

Single layer closure through skin & perichondrium but not cartilage
Pressure dressing
Close follow up

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22
Q

Findings of a Middle Ear Injury

A 
Hemotympanum
Amber or clear middle ear effusion
Otorrhea
Hearing deficit
Nystagmus
Ataxia
Retroauricular hematoma
Facial nerve deficit
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23
Q

Basilar skull fractures can be secondary to a fracture in which bones?

A

Temporal
occipital
Sphenoid
Ethmoid

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24
Q

Which bone is involved in 75% of basilar skull fractures?

A

Temporal bone

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25
What finding is indicative of basilar skull fracture and middle ear injury?
Hemotympanum
26
What is a huge sign of a basilar skull fracture?
Battle sign
27
What do you need to evaluate ottorhea?
Whether it's blood or CSF
28
What is the 2nd most common facial fracture?
Mandibular fracture
29
How to evaluate a patient with a mandibular fracture?
``` Evaluate the bite Tooth fractures or avulsions Trauma of tongue Sublingual ecchymosis Tongue blade test ```
30
Management of Mandibular Fractures
Airway management Hemostasis Surgical consult
31
Workup of Mandibular Fractures
History Physical Exam Xray CT scan
32
First steps in a blunt trauma to the neck
Airway stable? | Patient stable?
33
Can a patient with blunt trauma to the neck deteriorate rapidly?
Yes | Impending airway obstruction
34
Most common blunt injuries to the neck
MVA | Forward thrust
35
Initial Evaluation of Blunt Trauma to the Neck
``` ATLS principles Intubation hazard Respiratory distress Avoid cricothyroidotomies Detailed H&P if stable ```
36
Important History in the Diagnosis of Laryngeal Injury
``` Change in voice Pain Dyspnea Dysphagia Odynophagia Hemoptysis Inability to tolerate the supine position ```
37
Key Physical Exam Findings in the Diagnosis of Laryngeal Injury
``` Respiratory rate Stridor Contusions, abrasions in neck skin Subcutaneous emphysema Tracheal deviation Air bubbles or exposed tracheal cartilage ```
38
What to do with UNSTABLE patients with laryngeal injury?
Tracheotomy | Neck exploration
39
What to do with STABLE patients with laryngeal injury?
Direct laryngoscopy CT Bronchoscopy Esophagoscopy
40
Medical Management of Laryngeal Injury
``` 24 hours close observation Elevated head of bed Voice rest Anti-reflux meds Serial flexible fiberoptic exams Antibiotics for laryngeal mucosa disruption ```
41
Symptoms of a Nasal FB
Unilateral rhinitis Foul odor Epistaxis Pain
42
Diagnosis of a Nasal FB
Direct visualization | Xray
43
Treatment of a Nasal FB
Removal with forceps or suction
44
Where is the most common site of epistaxis?
Kiesselbach's plexus
45
Which nose bleeds are more severe?
Posterior bleed
46
Possible Underlying Causes of Local Epistaxis
``` Trauma Epistaxis digitorum FB Medications Vascular malformation Chronic sinusitis Neoplasm Polyps Irritants ```
47
Possible Underlying Causes of Systemic Epistaxis
``` Hemophilia Hypertension Leukemia Liver disease Anticoagulants Blood dyscrasias ```
48
Initial Management of Epistaxis
Blow nose to clear clots Spray topical vasoconstrictor Lean forward and direct compression for 20 minutes Examine nose with nasal speculum
49
Is an anterior or posterior bleed more common?
Anterior
50
Is an anterior or posterior bleed more serious?
Posterior
51
Steps to Stopping Epistaxis
Direct Compression Cautery Nasal packing or nasal tampon
52
How soon should you follow up with a patient after nasal packing or nasal tampon is placed?
24-48 hours
53
What can happen if nasal packing is too tight?
Necrosis
54
Who should place posterior packing?
ENT
55
Should patients with a posterior bleed be admitted or sent home?
Admitted
56
Epistaxis Complications
``` Severe bleeding Shock Sinusitis OM Pressure necrosis Toxic Shock Syndrome ```
57
What is the most common etiology of auricular cellulitis?
S. aureus | Pseudomonas
58
Which patients are at a high risk for auricular cellulitis?
Diabetics
59
Etiologies for Barotrauma
Flying Diving Blast injuries
60
Treatment for Barotrauma
Supportive Keep ear dry Recheck in 4 weeks Audiometry evaluation
61
What is the most common cause of TM rupture?
Infection
62
Treatment for TM Rupture
Keep ear dry until TM healed Most heal spontaneously Antibiotic drops
63
Antibiotics for TM Rupture
Ofloxicin drops | Oral antibiotics
64
Which antibiotics are contraindicated in a TM rupture and why?
Gentamicin Neomycin sulfate Tobramycin Ototoxicity
65
Presentation of Epiglottitis
``` Drooling Fever Hoarseness Dysphagia Stridor ```
66
Evaluation of Epiglottitis
Diagnosis clinical Lateral xray? Call ENT or surgeon
67
Treatment of Epiglottitis
Emergent ENT referrel IV antibiotics Intubation
68
Common Bugs of Epiglottitis
``` H. flu type B Strep pneumo Strep agalactiae Staph aureus Strep pyogenes M. cat ```
69
What is the main characteristic of epiglottitis?
Thumb print sign
70
Presentation of Peritonsillar Abscess
``` Severe unilateral throat pain Fever Dysphagia "Hot potato" voice Halitosis Neck pain Ear pain on affected side Headache Trismus ```
71
Management of Peritonsillar Abscess
Supportive therapy Work up Immediate ENT referral for I&D
72
What type of supportive therapy is needed in peritonsillar abscess?
Airway Fever Pain Hydration
73
Workup for Peritonsillar Abscess
+/- lateral neck xray | +/- CT with contrast
74
Anatomic Area of Retropharyngeal Abscess
Base of skull to the tracheal bifurcation
75
Define Retropharyngeal Abscess
Deep tissue neck infection
76
Serious/ Life-threatening Consequences of Retropharyngeal Abscess
Asphyxia | Spread of infection
77
Etiology of Retropharyngeal Abscess in Children
Usually from a lymph node that drains the H&N
78
Etiology of Retropharyngeal Abscess in Adults
Penetrating trauma Infection in the mouth/teeth Lymph nodes that drain the H&N
79
Signs & Symptoms of Retropharyngeal Abscess
``` Fever Dysphagia Neck pain Decrease cervical ROM Cervical lymphadenopathy Sore throat Poor oral intake Muffled voice Respiratory distress Stridor (children) Inflammatory torticollis ```
80
Workup of Retropharyngeal Abscess
Lateral soft tissue X-ray of neck | CT scan
81
Treatment of Retropharyngeal Abscess
Immediate ENT consult I&D IV hydration IV antibiotics
82
IV Antibiotics in Retropharyngeal Abscess
Clindamycin | Ampicillin-sulbactam (Unasyn)
83
Retropharyngeal Abscess Complications
Extension of infection into mediastinum Pleural/pericardial effusion Upper airway asphyxia Sudden rupture
84
Define Ludwig's Angina
Infection of the submandibular space | Progressive cellulitis of soft tissues of neck & floor of mouth
85
Etiology of Ludwig's Angina
Odontogenic Staph Strep Bacteroides
86
Signs & Symptoms of Ludwig's Angina
``` Dental pain Recent hx of dental procedures Neck swelling Neck pain Change in voice Dysphagia Glossitis Dyspnea Tacypnea Stridor ```
87
Physical Exam Findings of Ludwig's Angina
Bilateral submandibular swelling | Protruding tongue
88
Diagnostics of Ludwig's Angina
Clinical | CT
89
Treatment of Ludwig's Angina
Intubation I&D Broad spectrum antibiotics
90
Time Frame for a Laryngeal FB Removal
ASAP
91
Time Frame for a Bronchial FB Removal
Same day as diagnosis
92
Time Frame for an Esophageal FB Removal
Variable
93
What is the Cause of Pott's Puffy Tumor?
Complication of frontal sinusitis | Trauma
94
What can Pott's Puffy Tumor lead to?
Intracranial abscess | Venous sinus thrombosis
95
Workup of Pott's Puffy Tumor?
CT
96
Treatment of Pott's Puffy Tumor
Referrel to ENT Drainage Debridement IV antibiotics
97
Etiologies of 7th Nerve Palsy (Bell's Palsy)
Idiopathic Lyme Disease HSV Herpes zoster
98
What do you need to rule out with 7th nerve palsy (Bell's Palsy)?
Tumor
99
Treatment for Bell's Palsy
Steroids | +/- acyclovir
100
Common Bugs for Facial Cellulitis
Strep | Staph
101
Treatment for Facial Cellulitis
Antibiotics
102
What Does Facial Cellulitis Involve?
Deeper dermis & subcutaneous fat
103
What Does Erysipelas Involve?
Upper dermis & superficial lymphatics
104
Are Erysipelas Lesions Raised?
Yes
105
Treatment for Erysipelas
IV antibiotics for Strep & Staph
106
Complication of infections in the "triangle" of the face
Septic cavernous thrombosis

ENT (10 decks)

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