Flashcards in ENT emergenies Deck (60)
Primary concern with facial, head or neck trauma?
- maintain airway
- avoid nasal tracheal intubation
- consider: endotracheal intubation, laryngeal mask airway, cricothyroidotomy
- avoid NG tubes (or any tube in the nose) until the extent of the injury is determined (don't want to lose tubes in the brain!!)
- shock rarely develops from facial bleeding alone
- apply direct pressure
- may need nasal packing for epistaxis
What PE findings are you looking for with ENT fractures - nose specifically?
- CSF rhinorrhea
- septal hematoma
- nasal fracture
Significance of CSF rhinorrhea?
- how do you distinguish b/t clear nasal d/c and CSF?
- direct communication with CNS exists due to disruption of bony barrier and tear in dura
- significant risk for CNS infection
filter paper - look for halo sign
- test for glucose with glucose oxidase paper
When can a septal hematoma occur in adults, children?
- occur from trauma to anterior nasal septum
- adults: sig trauma and nasal fracture
- children: can occur with simple falls or minor altercations
Tx of septal hematomas?
- drain and pack
- abxs (augmentin) - if abscess suspected IV clindamycin and admission
- cartilage fracture: can result in formation of bilateral hematomas
Complications from not draining a septal hematoma?
- saddle nose deformity
- septal perforation
- septal abscess: may spread to paranasal and intracranial structures resulting in intracranial abscess, orbital cellulitis, cavernous sinous thrombosis
dx, what to look for on PE?
- most commonly fractured bone in the face
- dx usually based on PE
- nose usually edematous and tender
- look for displacement, crepitus, and epistaxis
- inspection with nasal speculum mandatory to rule out septal hematoma
- manage (closed reduction) 2-10 days post injury to allow for reduction of swelling
In an ENT trauma - what should you look for in and around the ears?
- auricular hematoma
- battle sign
What is auricular hematoma?
- direct trauma to auricle
- caused by separation of cartilage from perichondrium resulting in avascular necrosis
- drain within 7 days, compression dressing, daily follow up for few days, abx to cover staph
Etiologies of cauliflower ear?
- failure to drain hematoma
- stimulation of cartilage growth
- laceration through cartilage
- high piercings
- prevention with protective head gear for wrestling, boxing, rugby, and martial arts is key
Tx of ear laceration?
- can do single layer closure through skin and perichondrium but not cartilage (risk of hyperstim. cartilage)
- pressure dressing to prevent hematoma
- close f/u
- can use posterior auricular block for anesthesia
Findings of middle ear injury?
- amber or clear middle ear effusion
- otorrhea (clear or bloody ear canal drainage)
- hearing deficit by Weber and rinne tuning fork tests
- retroauricular hematoma (battle sign)
- facial nerve deficit may be sign of basilar skull fracture or assoc with middle ear injury
Basilar skull fracures - what bones are involved?
- can be secondary to fracture in temporal, occipital, sphenoid, or ethmoid bones
- temporal bone: involved in 75% of basilar skull fractures
What is a hemotympanum indicative of?
- basilar skull fracture and middle ear injury
What is Battle sign indicative of?
- basilar skull fracture
- occurs 6-12 hrs after injury
Ottorhea - examination?
- eval for blood or CSF
- may have hemorrhagic ottorhea from TM rupture or other middle ear injury
- leave penetrating fbs there until further eval with imaging
- leave clots in EAC if other signs of middle ear injury (ENT to eval)
- eval for further injury - skull fracture
What would you look for in trauma pt while doing the oral and mandibular exam?
- mandibular deviation, malocclusion of teeth, paresthesia, tongue blade test
Eval of mandibular fracture?
- 2nd most common facial fracture
- eval the bite - tongue blade test
- tooth fractures or avulsions
- look for trauma of tongue and sublingual ecchymosis
Management and workup of mandibular fracture?
- management: airway management, hemostasis, surgical consult
- workup: hx, PE, xray, or CT scan
First thing you need to do with pt that has blunt trauma to the neck?
- pt may deteriorate rapidly: leading to impending airway obstruction
- first thing - determine if airway and pt are stable or unstable!
Most common etiologies of blunt trauma to neck?
mechanism of injury: forward thrust
(in MVA - seat belts and air bags decrease incidence)
Initial eval of pt with blunt trauma to neck
- ATLS principles
- intubation hazardous
- respiratory distress: tracheotomy under local anesthesia
- avoid cricothyroidotomies: worsen injury
- if no acute breathing difficulties: get detailed hx and careful PE
History ?s in dx laryngeal injury?
- change in voice
- inability to tolerate the supine position
PE for dx laryngeal injury?
- neck skin: contusions, abrasions, or line pattern
- subq emphysema
- tracheal deviation
- open wound: air bubbles (tracheal disruption), exposed tracheal cartilage
- don't probe open wounds: may dislodge a hematoma
Dx laryngeal injury - studies?
- unstable: tracheotomy and neck exploration
- stable pts: flexible fiberoptic laryngoscopy in ER
CT scan, direct laryngoscopy, bronchoscopy, and esophagoscopy
Medical management for laryngeal injury?
- min of 24 hr close observation
- head of bed elevation
- voice rest
- anti-reflux meds
- serial flexible fiberoptic exams
- abxs for laryngeal mucosa disruption
When a pt that has suspected laryngeal trauma is exhibiting respiratory distress what should be performed?
- anticipate and calle ENT or surgeon
Sxs, dx, and tx of nasal fb?
- sxs: unilateral rhinitis, foul odor, epistaxis, pain
- dx: direct visualization (nasal speculum or rhinos copy) or Xray
- tx: remove with forceps or suction