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Flashcards in ENT Emergencies Deck (106)
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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