ENT emergencies Flashcards by Louise Emerson

what is epistaxis

noose bleed

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where do you asses sensation in a nasal trauma

infraorbital- where infraorbital nerve runs

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what motor nerves do you sens in a nasal trauma

CN 3,4 and 6

eye movements

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what must you exclude in a nasal trauma

a septal haematoma

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what is the relevance of a septal haematoma

can cut off the blood supply to cartilage- necrosis- can also lead to infection
needs to be evacuated

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what is the blood supply to the nasal cartilage

perichondrium

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what is the treatment for a nasal fracture

based on deviation, breathing, cosmesis
evacuate any septal haematoma
review in ENT clinic 5-7 days post injury
consider digital manipulation <3 weeks, after this bones fixed

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what are the complications of a nasal fracture

epitaxis- especially anterior ethmoid artery
CSF leak- created risk of meningitis
anosmia- cribiform plate fracture (injury CN 1)

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why do you get recurrent epitaxis after a nasal fracture

as artery will go into spam and then stop every few days

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what is the main blood supply to the nose

sphenopalatine, poster and anterior ethmoid arteries

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what is the anastamosis of the nasal arteries called

Kiesselbach’s area- common site for epitaxis to occur

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how do you manage epitaxis

external pressure to the nose, sit forward
ice
cautery
nasal packing
if doesnt stop within 20 mins then go to hospital

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how do you manage a severe epitaxis

resus if necessary 
stop flow- pressure, ice, topical vasoconstrictor
remove clot- suction, nose blowing 
anterior rhinoplasty 
cautery/pack 
arterial ligation

never sedate- can aspirate on the blood

reversal of anticoagulants
correction of clotting abnormalities
platelet transfusion
hypertension Tx

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what is the management for a CSF leak after a nasal fracture

usually settles within 10 days

if not needs repair

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what is the risk of a CSF leak

ascending infection- meningitis

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where might the fracture be when there is a CSF leak

cribiform plate

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what are 4 ear emergencies

pinna haematoma
ear lacerations
temporal bone fractures
sudden SN hearing loss

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what is a pinna haematoma

sub perichondral haematoma

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what is the treatment for a pinna haematoma

need to be evacuated as cartilage can die- causes cauliflower ears = aspirate 
incision and drainage 
pressure dressing (stays on for a week)
avoid contact sports for a few weeks

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what is the management for a ear laceration

debridement 
closure (primary) 
reconstruction 
usually LA 
antibiotics (to prevent chondritis)

what must you ask about in a temporal fracture

injury mechanism 
hearing loss
facial palsy 
vertigo 
CSF leak (coming out of the ear) 
associated injuries

what is a battle sign

bruising behind the ear, suggest a base of skull fracture

how do you test the facial nerve

do facial movements

what are the types of temporal fractures

longitudinal vs transverse

otic capsule sparing vs involving

what are the features and common complications of a longitudinal temporal fracture

most common type of temporal # caused by lateral blows fracture line parallels the long axis of the petrous pyramid bleeding from the external canal due to laceration of skin an ear drum haemotympanum (conductive HL) ossicular chain disruption (Conductive HL) facial palsy 20% CSF otorrhoea usually spare the otic capsule

what are the features and complications of a transverse temporal fracture

``` 20% caused by frontal blows can cross IAM damaging auditory and facial nerves SN HL due to damage of 8th CN facial nerve palsy 50% vertigo ``` less common temporal fracture but more likely to get hearing loss and facial paralysis

what can cause conductive hearing loss

fluid TM perforation ossicular problem (dislocation)

what is the management for a conductive hearing loss

depends on cause | may need hearing ad or ossiculoplasty (to realign the ossicles)

what is the management for a sudden (<3 days) senorineural hearing loss (at least 30 dB at 3 frequencies)

weber test to make sure it sensorineural | give steroids asap

what can cause sudden sensorineural hearing loss

immune mediated, idiopathic, viruses

what is the rinne test

tuning fork on mastoid process and then beside ear. if patient says its louder going through air then positive rinne test (air conduction is intact, SN HL or normal). if patient says it is louder through bone then negative result and is a conductive hearing loss (air conduction affected)

what is quiter/ louder in SN and conductive HL

SN sounds will be percieved to be quieter on affected side | in conductive sounds on affected sides seems louder (up regulation, trapping of sound waves)

what is the webers test

compares bone conduction tuning fork medially on patients head should be heard equally on both sides if sound louder on one side= lateralisation (SN HL lateralises to the UNAFFECTED SIDE- louder in healthy ear) (CHL sound lateralises to the AFFECTED SIDE- will be louder in abnormal ear)

what foreign body do you always remove immediately

batteries

what is zone 1 for knife neck injuries

included trachea, oesophagus, thoracic duct, thyroid, vessels (brachiocephalic, subclavian, common carotid, thyrocervical, spinal cord

what is zone 2 for knife neck injuries

larynx, hypopharynx, CN 10, 11 and 12, vessels (carotids, internal jugular), spinal cord

what is zone 3 for knife neck injuries

pharynx, cranial nerves, vessels (carotids, IJV, vertebral), spinal cords

what aerodigestive features should you look out for in a knife neck injury

dsypnoea, hoarseness, dysphonia, dysphagia, haemoptysis

when is a neck injury penetrating

if it goes through the platysma | if doesn't go beneath this then can close in a and e

why do you do a chest x ray in a knife neck wound

haemopneumothorax, emphysema

what needs urgent exploration in a knife neck injury

expanding haematoma, hypovolaemic shocl, airway obstruction, blood in aerodigestive tract

what allows the spread of a deep neck space infection

extends from tonsils or oropharynx | common in parapharyngeal (infection from tonsils) space which can spread downwards the retropharyngeal space

what are the features of a deep neck space infection

sore throat, unwell, limited neck movement | febrile, trismus, red/tender neck

what is the management for a deep space neck infection

fluid resus, IV antibiotics, incision and drainage of neck space

what can happen if a swallowed foreign body is delayed in its removal

swelling and oedema, making it a lot harder to remove

what is the weak point of the orbit

infraorbital groove

what are the common features of an orbit fracture

``` pain, decreased visual acuity, diplopia hypoaesthesia in infraorbital region periorbital ecchymosis (skin discolouration) oedema enopthalmos restriction of ocular movement tear drop sign on CT ```

what is the management of orbital fractures

``` conservative surgical repair if: -entrapment -large defect -significant enopthlamos ```

what are the types of le fort fractures

1. horizontal (above teeth apices) 2. pyramidal 3. transverse (craniofacial dysjunctions)