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Minor Injury Management Flashcards

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1
Q
  1. Hand, Fingers, & Wrist
  2. Elbow
  3. Shoulder
    History Taking
    10 Points
A
  1. Presenting Complaint.
  2. History of Presenting Complaint (traumatic or atraumatic)
  3. Self-management / OTC Analgesia
  4. Unwell? / Fever? / Pain?
  5. Hand Dominance
  6. If wound(s), ask tetanus status
  7. Past Medical History
  8. Drug History
  9. Allergies
  10. Social History (Lives Alone? / Frail?)
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2
Q

Opening Of Each OSCE
4 Points

A
  1. Wash hands
  2. Introduce myself, including role
  3. Patient name and DOB
  4. Explain examination and gain informed consent
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3
Q

Hand, Fingers, & Wrist
Look
7 Points

A
  1. Skin appearance, colour change
  2. Deformity
  3. Wounds
  4. Erythema
  5. Swelling
  6. Bruising
  7. Scars
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4
Q

Hand, Fingers, & Wrist
Feel
3 Points

A
  1. Temperature (Warmth)
  2. Bony Tenderness: DIPJ, PIPJ, MCPJ / Wrist / Elbow (INCLUDING BONY STRUCTURES IN BETWEEN)
  3. If atraumatic, check for crepitus.
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5
Q

Hand, Fingers, & Wrist
Move
4 Points

A
  1. Test ROM (Active or Passive)
  2. Wrist - Extension & Flexion
  3. Finger - Extension & Extension
  4. Thumb Flexion / Extension / Abduction / Adduction / Opposition
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6
Q

Hand, Fingers, & Wrist
Special Tests
6 Points

A
  1. ASB Tenderness / Scaphoid Tubercle Tenderness / Pain on Axial Compression of the Thumb
  2. FDS
  3. FDP
  4. Extensor Tendons & Collateral Ligaments
  5. Carpal Tunnel: Tinels Test
  6. Flexor Pollicis Longus (FPL) / Extensor Pollicis Longus (EPL) / Extensor Pollicis Brevis (EPB) / Abductor Pollicis Longus (APL)
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7
Q

Hand, Fingers, & Wrist
Neurovascular
4 Points

A
  1. CRT
  2. Pulse (Radial & Ulna)
  3. Sensation (First Web Space)
  4. Radial, Medial, & Ulna Nerves: Kumar’s Test
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8
Q

Colles Fracture (Common) – Over 65 Management

A
  1. Non-operative management unless severe deformity or NV compromise
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9
Q

Colles Fracture (Common) – Under 65 Management

A
  • Consider surgery for intra-articular involvement, dorsal tilt, and patient needs
  • Manipulation for >10mm dorsal angulation or >5mm shortening of radius
  • Pain relief: IV regional anaesthesia (gold standard); local hematoma block with gas and air if IV anaesthesia not feasible
  • Apply back slab while in traction
  • Perform recheck of NV status and re-x-ray
  • Referral to fracture clinic
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10
Q

Elbow
Look
8 Points

A
  1. Whole Limb
  2. Deformity
  3. Wounds
  4. Erythema
  5. Swelling
  6. Bruising
  7. Scars
  8. Carrying Angle
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11
Q

Elbow
Feel
4 Points

A
  1. Temperature (Warmth)
  2. Bony / Ligament Tenderness
  3. Crepitus
  4. Joint Above / Below
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12
Q

Elbow
Move
4 Points

A
  1. Active Or, if needed, Passive ROM
  2. Flexion 135 degrees
  3. Extension 0 degrees
  4. Pronation/Supination 180 degrees
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13
Q

Elbow
Special Tests
3 Points

A
  1. Tests for Lateral / Medial Epicondylitis
  2. Tennis Elbow: Pain Increases Over Lateral Epicondyle On Passive Stressing of Wrist Flexion with Elbow Extension
  3. Golfer’s Elbow: Pain Increases Over Medial Epicondyle On Passive Wrist Extension With Elbow Extension
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14
Q

Elbow
Neurovascular
3 Points

A
  1. Pulses (Radial / Brachial)
  2. CRT
  3. Sensation to Limb
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15
Q

Fractured Radial head / Neck
Management
3 Points

A
  1. Collar & Cuff
  2. Surgery if displaced #
  3. Pain relief
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16
Q

Olecranon Fracture
Management
4 Points

A
  1. Refer to Orthopaedics same day
  2. May advise collar & cuff and return to fracture / elbow clinic
  3. May be for non-urgent theatre if closed #
  4. Pain relief
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17
Q

Supracondylar Fracture
Management
3 Points

A
  1. Pain Management
  2. Above Elbow Back Slab
  3. Refer to Orthopaedics immediately – as Theatre Likely
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18
Q

Elbow Dislocation
Management
3 Points

A
  1. Reduction Under Sedation
  2. Perhaps Surgery if Unstable Due to Complete Joint Capsule Rupture
  3. Pain Management
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19
Q

Elbow
Monteggia Fracture Dislocation
Management
3 Points

A
  1. Closed Reduction in Paediatrics Usually
  2. Open reduction and Internal Fixation (ORIF) of the Ulna in Adults
    Above Elbow Backslab
  3. Pain Management
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20
Q

Elbow
Galeazzi Fracture Dislocation
Management
3 Points

A
  1. Open reduction and Internal Fixation (ORIF) of the Distal Radius followed by Stability of the Distal Radioulnar Joint (DRUJ), possibly DRUJ Pinning or ORIF of the DRUJ
  2. Above elbow backslab
  3. Pain Management
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21
Q

Elbow
Isolated Ulna Fracture
Management
4 Points

A
  1. Below Elbow Dorsal Backslab
  2. Pain Management
  3. Refer to Orthopaedics / Fracture clinic – usually no immediate assessment needed
  4. Safeguarding Referral if Appropriate
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22
Q

Pulled Elbow
Management
1 Point

A
  1. Manipulation is performed by actively supinating the forearm with the elbow flexed and whilst palpating the radial head. A click and pain are followed, by a return to active movement when successful
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23
Q

Elbow
Bicep Injuries
Management

A
  • Proximal rupture- usually conservative
  • Distal rupture- REFER to ortho same day – for surgery
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24
Q

Lateral / Medial Epicondylitis
Management

A
  • Not for immobilisation
  • Avoid oversuse
  • Rest
  • Ice
  • Pain relief
  • NSAID’s if not contraindicated
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25
Shoulder Look
- Whole Limb - Skin Appearance, including Skin Tenting - Deformity - Normal and Symmetrical Contour? - Winged Scapula - Wounds - Erythema - Swelling - Bruising - Scars - Bicep Contour
26
Elbow Feel
- Temperature (Warmth) - Bony Tenderness - Ligament / Joint Line Tenderness - Joint Above & Below: C-Spine & Elbow - Bicep / Triceps tendon Assessment
27
Shoulder Move
- Test ROM (Active or Passive) - Flexion / Extension / Abduction / Adduction / External Rotation / Internal Rotation - Resisted Tests - Look out for Crepitus / Impingement
28
Elbow Special Tests
- Rotator Cuff - Empty can - Resisted external rotation in abduction - Hornblowers - Lift off
29
Shoulder Neurovascular
- Pulses (Radial / Brachial) - CRT - Sensation to limb - Axial Nerve and Distal Limb
30
Shoulder Clavicle Fractures Management
- Poly sling - Pain relief - Surgery dependent upon fracture position - Mid shaft - surgery more likely and need same day discussion with ortho
31
Shoulder Acromioclavicular Joint (ACJ) Disruption Management
- Usually managed conservatively dependent on grading of the disruption - May need surgery - Physio - Collar & Cuff - Pain Management
32
Shoulder Humeral fracture-Proximal Management
- Usually managed conservatively - High arm collar & cuff giving traction to the # - Physio & rehab - Maintain patient safety on discharge ?social assessment - Adequate pain relief
33
Shoulder Humeral fracture-mid shaft Management
- Ensure NV intact - Usually conservative unless comminuted - Hanging U Cast - Surgery if vascular/brachial plexus injury, open #, floating segment - Pain Management
34
Shoulder Scapula Fracture Management
- Senior review and same day ortho referral - CT - Pain Management
35
Anterior Shoulder dislocation Management
- Check axial nerve, radial pulse, CRT! - Variety of reduction methods 1. Leverage 2. Traction-semi-supine position, abduction and flexion, slow continuous traction - Some need reduction under sedation if difficult or Hill-Sach’s lesion
36
Shoulder Supraspinatus Tendonitis Management
- Steroid injection - Pain relief - Physio
37
Knee History Taking
- How can I help? - SOCRATES - Any previous injuries? - How do you feel in yourself? - What have you tried to help with the pain? - Would you like any pain relief now? - Occupation - Tetanus Status (If Wound(s)) - PMH - DH - Allergies - SH (Particularly If Elderly & Lives Alone) - Atraumatic specifics Any new or repetitive movements e.g. DIY/ new or increased sporting activities - Specifics of the mechanism of the injury- valgus or varus strain, hyperextension, direct impact? - Did the knee swell? Immediate or delayed? - Does it ‘click’? - Does it ‘lock’? - Does it ‘give way’?
38
Knee Look
- Whole Limb - Skin Appearance - Deformity - Wounds - Erythema - Swelling - Effusion, Bursitis, Bakers Cyst - Bruising - Scars - Valgus/Varus Deformity? - Quad Contour / Muscle Wastage - Drop Foot?
39
Knee Feel
- Temperature (Warmth) - Bony Tenderness - Ligament / Joint Line Tenderness - Joint Above & Below: Hip, lower limb, foot & ankle - Effusion tests: Patella tap and sweep tests
40
Knee Move
- Test ROM (Active or Passive) - Flexion / Extension - Resisted Tests - Look out for Crepitus
41
Knee Special Tests
- Valgus Stress Test For Medial Collateral Ligament (MCL) - Varus Stress Test For Lateral Collateral Ligament (LCL) - Lachmans For Anterior Cruciate Ligament (ACL) - Posterior Draw For Posterior Cruciate Ligament (PCL) - Straight Leg Raise - patella & quad tendons
42
Knee Neurovascular
- Popliteal pulse - CRT - Sensation to Limb - First Web Space
43
Knee Anterior Cruciate Ligament (ACL) Injury Management
- Does not heal when torn- requires surgical reconstruction. Useful info: Meta- analysis trends favour early surgery for optimum rehab Average surgical age between 2013-2021 is 30 Anterior drawer test (Lachman tests)
44
Knee Posterior Cruciate Ligament (PCL) Injury Management
- If in isolation Grade 1 &2 managed conservatively. Useful Info: Posterior Drawer Test
45
Knee Medial Collateral Ligament (MCL) Injury Management
- Management Several methods - Rest - Patellar/soft tissue mobilisations and frictional massage, gait training, cold therapy etc. - Rarely surgical intervention is necessary. Useful info: VaLgus stress (foot Leaves the midline)
46
Knee Lateral Collateral Ligament Injury Management
- Usually manged conservatively is in isolation Useful info: VaRus stress (foot Returns to the midline)
47
Quadricep Tendon Injury Management
- Compete rupture = surgical repair - Partial tear = immobilization 3-6 weeks
48
Patella Tendon Injury Management
- Early surgical repair is favored
49
Knee Meniscal injury Management
- Dependent of location, severity, patient individual
50
Patella Fractures Management
- Often conservatively - Surgically if displaced
51
Patella Dislocation Management
- Reduction on scene usually - Physio
52
Knee Femoral Condyle Fractures Management
- Surgical fixation or conservative depending on severity
53
Knee Tibial Plateau Fractures Management
- CT /MRI - Surgery – Managed externally then later open reduction and internal fixation (ORIF)
54
Knee Atraumatic Septic Arthritis Management
- Immediate referral - Bloods, infection markers, cultures, cannula, IV ABX. ?Joint aspiration
55
Knee Loose Bodies Management
- Request a ‘tunnel view’ if suspicious of - Non-immediate referral for investigation ?orthoscopy/ wash out
56
Knee Reiter’s Syndrome- Reactive Arthritis
- Steroids, ABX, NSAIDs - Treatment of the primary infection - Bloods for infection markers - Can take 6 months to improve
57
Knee Bursitis Management
- Treat possible infection - Conservative management preferred - Aspiration usually not indicated
58
Chondromalacia Patella Management
- Education and physio - Usually conservative management- -stretching and strengthening the relevant muscles - If conservative fails- numerous surgical interventions
59
What are the OTTAWA Knee Rules?
- Age ≥55 - Isolated tenderness of the patella - Tenderness at the fibular head - Unable to flex knee to 90° - Unable to bear weight both immediately and in ED
60
Hip History
- How can I help? - SOCRATES - Any previous injuries? - How do you feel in yourself? - What have you tried to help with the pain? - Would you like any pain relief now? - Occupation - Tetanus Status (If Wound(s)) - PMH - DH - Allergies - SH (Particularly If Elderly & Lives Alone) - Atraumatic specifics Any new or repetitive movements e.g. DIY/ new or increased sporting activities Additional hip history points: Fall, direct trauma to hip, unable to mobilise Location of any pain - Pain is usually felt in the groin, but can be referred to the anterior thigh, the knee or buttock. Hip pain is usually aggravated by activity Preceding symptoms to fall Co-morbidity (CVS, Resp, previous hip injuries, THR, DHS) Pre-fracture mobility Social status—live alone, stairs, etc Medications—anticoagulants, ß-blockers, anti-HTN
61
Hip Look
- Can the patient weight bear? - Gait – Limping, leg length, turning, waddling, Trendelenburg’s - Haematoma/Skin discolouration - Wounds - Scars - Deformity - Shortening - Abduction - External rotation - Swelling
62
Hip Feel
- Femur - Knee - Abdomen - Dorsal foot Pulses - Distal sensation
63
Hip Move
- Active - Straight leg raise - Passive Additional info: The hip is a ball-and-socket joint – which allows: Flexion Extension Abduction Adduction internal/external rotation and the movement of circumduction
64
Hip Fracture Management
- Analgesia - Cannulate - Take Bloods - FBC - Clotting Screen, ?INR - U&E, ?Calcium - X ray request - Hip - Pelvis - (CXR)
65
Lower Leg, Ankle, & Foot History
- How can I help? - SOCRATES - Any previous injuries? - How do you feel in yourself? - What have you tried to help with the pain? - Would you like any pain relief now? - Occupation - Tetanus Status (If Wound(s)) - PMH - DH - Allergies - SH (Particularly If Elderly & Lives Alone) - Atraumatic specifics Any new or repetitive movements e.g. DIY/ new or increased sporting activities
66
Lower Leg, Ankle, & Foot Look
- Gait / Mobility - Foot Positioning - Valgus / Varus Hind Position - Whole Limb - Deformity - Wounds - Erythema - Swelling - Bruising - Scars
67
Lower Leg, Ankle, & Foot Feel
- Temperature (Warmth) - Bony / Ligament Tenderness - Joint Above: Knee - Crepitus
68
Lower Leg, Ankle, & Foot Move
- Test ROM (Active or Passive) - Dorsiflexion / Plantar Flexion - Inversion / Eversion - Resisted Tests - Power - FWB / PWB / NWB
69
Lower Leg, Ankle, & Foot Special Tests
- Simmonds-Thompson Test For Achilles - Gastrocnemius/Calf Assessment
70
Lower Leg, Ankle, & Foot Neurovascular
- Check dorsalis pedis / posterior tibial pulses - CRT - Sensation to Limb - Distal & 1st Web Space
71
OTTAWA Ankle Rules
- Bony tenderness along distal 6 cm of the posterior edge of fibula or tip of lateral malleolus - Bony tenderness along distal 6 cm of the posterior edge of tibia/tip of medial malleolus - Bony tenderness at the base of the 5th metatarsal - Bony tenderness at the navicular - Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
72
Lower Leg, Ankle, & Foot Metatarsal Fracture Management
- Treatment is often pain dependent - If able to WB - Walker boot, PWB crutches (if needed) - Ref to # clinic - Small avulsions - manage as sprain - Jones - Ref ?Walker boot ?PKBS ? Surgery
73
Lower Leg, Ankle, & Foot Stress Fractures Management
- Often missed as usually not see straight away - Brought back at 10-14 days if suspicious. Periosteal reaction may then be seen - Usually managed conservatively - walker boot - Reduced physical activity - Bone density scan
74
Lower Leg, Ankle, & Foot Lisfranc Management
- Same day ref to ortho - Often will ask for a weight-bearing view to check for further displacement - NWB cast if confirmed - VTE risk assessment - CT - ?Surgical Fixation
75
Lower Leg, Ankle, & Foot Calcaneus Fracture Management
- Pain relief - Ortho same-day ref - Open reduction and internal fixation (ORIF) - Non-weight-bearing below-knee back slab - VTE prophylaxis should be considered
76
Lower Leg, Ankle, & Foot Cuboid / Navicular / Cuneiform Fractures Management
- May be conservative or operative if grossly displaced - Walker boot or NWB cast (fracture dependent)
77
Lower Leg, Ankle, & Foot Toe fractures and dislocations Management
- Displaced fractures need manipulating as will cause ongoing pain, cosmetic and practical concerns for the patient - Dislocations require reducing - Greater to fractures may require surgical fixation - Darco shoe - Strapping may be required as comfort for 2-5 toe suspected fractures
78
Lower Leg, Ankle, & Foot Planter Fasciitis Management
- Reduction in activity - Ice & massage - Night splint - NSAIDs and pain relief - Correct footwear
79
Lower Leg, Ankle, & Foot Talus Fractures Management
- Ortho ref and discussion - Avulsion - Often a walker boot - Displaced fracture - CT, NWB, below knee back slab, VTE prophylaxis if indicated
80
Lower Leg, Ankle, & Foot Talar Shift Management
- Ref to ortho same day - ?CT - NMW - ?Surgery
81
Lower Leg, Ankle, & Foot Isolated Posterior Malleolus Fractures Management
- Dependent on size / displacement / other fractures / ability to WB - Discuss with ortho
82
Lower Leg, Ankle, & Foot Pilon & Tibial Plafond Fractures Management
- Discussed with ortho same day - CT - NWB
83
Lower Leg, Ankle, & Foot Grade 1 Sprain
- Often inversion injury - Anterior Talo-Fibular Ligament (ATFL) stretched - microscopic tears or ligament fibres - Joint is stable - Mild swelling - Little / No ecchymosis around the lateral aspect of the ankle - Pain over ATFL with mild restriction ROM - Possibly unable to WB
84
Lower Leg, Ankle, & Foot Grade 2 Sprain
- Moderate injury to later ligaments - Complete tear of the Anterior Talo-Fibular Ligament (ATFL) with a partial calcaneofibular ligament (CFL) tear - Mild / Moderate joint instability - Moderate swelling - Pain to surrounding anterolateral aspect of ankle - Restricted ROM - Degree of instability - Bruising and ecchymosis present
85
Lower Leg, Ankle, & Foot Grade 3 Sprain
- Severe Injury - Both Anterior Talo-Fibular Ligament (ATFL) & calcaneofibular ligament (CFL) will be ruptured with a capsule tear - Marked ankle instability - Swelling, bruising, ecchymosis +++ along the lateral aspect of the ankle and calcaneum - Pain over ATFL & CFL - Unstable joint - Laxity when testing anterior draw & talar inversion tilt
86
Lower Leg, Ankle, & Foot Sprain Management
P - Protection R - Rest I - Ice C - Compression E - Elevation
87
Lower Leg, Ankle, & Foot Proximal Fibula Fractures Management
- In isolation, if able to WB-PWB crutches then fracture clinic - If unable to WB, is it an isolated injury? NWB BKBS and ?ortho ref
88
Lower Leg, Ankle, & Foot Stress Fractures Tibia / Fibula Management
- If no initial fracture seen, return in 10-14 days for re-X-ray - Be aware of risk of fracture pattern recognition - ?Walker boot to aid foot stability and prevent re-injury - Fracture clinic ref if seen
89
Lower Leg, Ankle, & Foot Gastrocnemius Tear Management
- Self-care - stretching - Avoid foam rolling until injury has settled as can increase scar tissue formation - Physio if significant pain, bruising, poor recovery progression - Possible PWB crutches
90
Lower Leg, Ankle, & Foot Achilles Tendon Rupture Management
- Refer to ortho same day - Equinus BKSB - NW-WB with crutches - Non-WB with crutches - VTE high risk
91
ENT Nasal Examination External Nose Inspection
- Look for skin changes, such as lesions / signs of trauma. - Stand behind the patient and gently tilt their head back, checking for any deviation in the nasal bones or cartilage suggestive of a fracture.
92
ENT Nasal Examination External Nasal Palpation
- Palpate the nasal bones and cartilage for tenderness, irregularity, and deviation.
93
ENT Nasal Examination Nasal Cavity Inspection
- Gently elevate the tip of the patient's nose with your thumb - Use pen torch to illuminate the nasal cavity - Inspect the nasal mucosa (including the septum) for any abnormalities, such as blood, septal hematoma, septal deviation, or nasal polyp.
94
ENT Nasal Examination Nasal Cavity Inspection, using using an otoscope with a large speculum attached (inserting only the very tip into the nose) or using a nasal speculum (also known as Thudicum’s speculum), which widens the nasal cavity to allow you to peer in using a light source.
Nasal vestibule: inspect for inflammation, ulceration or oedema affecting the nasal mucosa. Nasal septum: note any polyps, deviation, perforation, haematoma, superficial vessels or areas of cautery. Inferior turbinates: note any asymmetry, inflammation or polyps.
95
ENT Nasal Examination Assess air flow
1. Place your thumb over the nostril not being assessed to occlude airflow. 2. Ask the patient to breathe in through their nose and note the degree of airflow. 3. Repeat assessment on the other nostril, noting any difference in apparent airflow. Interpretation Reduced airflow through a particular nostril may indicate the presence of something blocking that air passage, such as a polyp, deviated nasal septum or foreign body.
96
ENT Nose Septal Haematoma Management
IT IS A SURGICAL EMERGENCY! Urgent I&D ENT
97
ENT Nasal Fracture Management
If risk of cosmetic deformity: - ENT clinic follow up 4-7 days - Advise not to blow nose - A clear referral must be made
98
ENT Ear Start off with gross hearing test
- Stand behind the patient and whisper three different numbers approximately 60cm from the patient's ear and ask the patient to repeat it - Mask the ear not being tested by rubbing the tragus
99
ENT Ear Weber's test
Tap a 512Hz tuning fork and place in the midline of the forehead. The tuning fork should be set in motion by striking it on your knee (not the patient’s knee or a table). 2. Ask the patient “Where do you hear the sound?” These results should be assessed in context with the results of Rinne’s test before any diagnostic assumptions are made: Normal: sound is heard equally in both ears. Sensorineural deafness: sound is heard louder on the side of the intact ear. Conductive deafness: sound is heard louder on the side of the affected ear.
100
ENT Ear Weber's test
1. Place a vibrating 512 Hz tuning fork firmly on the mastoid process (apply pressure to the opposite side of the head to make sure the contact is firm). This tests bone conduction. 2. Confirm the patient can hear the sound of the tuning fork and then ask them to tell you when they can no longer hear it. 3. When the patient can no longer hear the sound, move the tuning fork in front of the external auditory meatus to test air conduction. 4. Ask the patient if they can now hear the sound again. If they can hear the sound, it suggests air conduction is better than bone conduction, which is what would be expected in a healthy individual (this is often confusingly referred to as a “Rinne’s positive” result).
101
ENT Ear External Ear Inspection
- Inspect the pinnae for: Asymmetry: by comparing the pinnae you may identify subtle unilateral pathology. Deformity of the pinnae: this may be acquired (e.g. cauliflower ear) or congenital (e.g. anotia, microtia, low-set ears). Ear piercings: can be a potential source of infection, an allergen and a cause of trauma. Erythema and oedema: typically associated with otitis externa. Scars: indicative of previous surgery. Skin lesions: look for evidence of pre-malignant (actinic keratoses) and malignant (e.g. basal cell carcinoma, squamous cell carcinoma) skin changes. - Inspect the mastoid region: Erythema and swelling: typically associated with mastoiditis. Scars: indicative of previous surgery (e.g. mastoidectomy). - Inspect the pre-auricular region (in front of the ear): Pre-auricular sinus/pit: a common congenital deformity that appears as a dimple in the pre-auricular region. These sinuses can sometimes become infected and require surgical drainage. Lymphadenopathy: typically associated with an ear infection (e.g. otitis media, otitis externa). - Inspect the conchal bowl for signs of active infection such as erythema and purulent discharge.
102
ENT Ear Palpation
Palpate the tragus for tenderness which is typically associated with otitis externa. Palpate the regional lymph nodes: Pre-auricular lymph nodes Post-auricular lymph nodes
103
ENT Ear Otoscopy
- Inspect the external auditory canal for: - excessive ear wax (conductive hearing loss) - erythema and oedema (otitis externa) - discharge (otitis externa or otitis media with associated tympanic membrane perforation) - foreign bodies
104
ENT Ear Tympanic Membrane Assessment
Systematically inspect the four quadrants of the tympanic membrane (TM) to avoid missing pathology. - Colour (pearly grey and translucent) - Shape (healthy should be flat) - Light reflex (healthy: cone-shaped reflection of light should appear in the anterior inferior quadrant) - Perforation (infection, trauma, cholesteatoma, and tympanostomy tubes) - Scarring (can result in significant conductive hearing loss if it is extensive)
105
ENT Ear Otitis Externa Management
Treat with antibiotics – steroid otic preparations Gentisone HC Adequate analgesia Aural toilet Small cotton wick should be placed in ear canal Avoid swimming ENT follow-up Complications Malignant otitis externa Cellulitis and perichondritis
106
ENT Ear Otitis Media Management
- Antibiotics - Amoxicillin - Analgesia - ENT/GP follow up
107
ENT Ear Acute Mastoiditis Management
Need aggressive treatment- Immediate ENT referral,IV antibiotics,CT scan Complications-meningitis,subperiosteal abscess,CN palsy
108
ENT Ear Foreign Body Management
Golden Rule – one good attempt Usually common in children,insects usually in adults Drown insect with oil and suction it Remove other FB with forceps or suction
109
ENT Throat General Inspection of Face
- Swelling & asymmetry (Parotid gland swelling > Loss of jaw angle > hamster-like appearance) -
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ENT Throat Oral Cavity Inspection Lips
- Angular stomatitis - Hyperpigmented macules - Ulceration
111
ENT Throat Oral Cavity Inspection Tongue
- Ulceration / Lesions - Oral candidiasis - Glossitis - Leukoplakia
112
ENT Throat Oral Cavity Inspection Teeth
- Missing teeth - Nicotine / Tar Staining - Tooth Decay
113
ENT Throat Oral Cavity Inspection Gums
- Gingivitis - Periodontitis - Ulceration
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ENT Throat Oral Cavity Inspection Floor of mouth
- Submandibular Gland - Ulceration
115
ENT Throat Oral Cavity Inspection Buccal mucosa and Parotid Duct on each side of Tongue
- Ulcers / Lesions - Leukoplakia - Parotid Gland Sialolithiasis / Sialoadenitis - Pleomorphic Adenoma
116
ENT Throat Oral Cavity Inspection Uvula
- Deviation (peritonsillar swelling, CNX palsy) - Papillomas - Oral Candidiasis
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ENT Throat Oral Cavity Inspection Palate
- Oral Candidiasis - Ulceration - Papillomas
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ENT Throat Oral Cavity Inspection Tonsils
- Enlargement / Asymmetry - Ulceration / Stones
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ENT Throat Oral Cavity Inspection Pharyngeal Arches
- Peritonsillar Swelling - Pharyngitis
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ENT Throat Tonsillitis
- Analgesia - Antibiotics - Penicillin v 500 mg QDS - Follow up GP
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ENT Throat Quinsy – Peritonsillar Abscess
- Incision & Drainage - Aspiration - Refer to ENT
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Head Injury History
- Mechanism/Time of Injury - Any Loss of consciousness - Amnesia before/after - Nausea & vomiting - Headache - Fits - Visual Disturbance - Weakness - Numbness - CSF Fluid from Ears / Nose - PMH - DH: watch out for warfarin / sedatives - Recreational drugs – alcohol etc. - Other Injuries esp neck - Social history (Ensure social support available at home)
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Head Injury Assessment
- Consider possibility of neck injury - Assessment of conscious level – Glasgow Coma Scale Vital signs - BM if altered conscious level - External signs of trauma - Basic neurological examination - Consider other injuries
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Head Injury Signs of Vault Fracture
- Boggy swelling or depression - Penetrating injury
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Head Injury Signs of Basal Skull Fracture
- Peri-Orbital / Post-Auricular Bruising - Otorrhoea - Rhinorrhea - Haemotympanum - Subconjunctival Haemorrhage
126
Head Injury Glasgow Coma Scale Eyes Opening
- Spontaneous: 4 - To Speech: 3 - To Pain: 2 - None: 1
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Head Injury Glasgow Coma Scale Best Verbal
- Orientated: 5 - Confused: 4 - Inappropriate Words: 3 - Incomprehensible Sounds: 2 - None: 1
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Head Injury Glasgow Coma Scale Best Motor
Obeys Commands: 6 Localises to Pain: 5 Flexion: 4 Abnormal Flexion: 3 Extension: 2 None: 1
129
Head Injury Cranial Nerves 1. Olfactory (Smell)
● Any current colds? ask patient to blow their nose ● Any change in sense of smell ● Ask patient to identify various scents
130
Head Injury Cranial Nerves 2. Optic (Vision)
● Pupils, Size, Position, Ptosis ● Visual Acuity using a Snellen chart/or newspaper at arm's length ● Visual Fields ● Pupil reflexes ● Direct reflex ● Consensual reflex ● Accommodation reflex ● Fundoscopy Examination
131
Head Injury Cranial Nerves 3. Occulomotor 4. Trochlear 6. Abducens Eye Movements
● Eye Movement 6 Cardinal H Movements ● Checking for Nystagmus ● Convergence by moving finger towards bridge of the patient's nose
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Head Injury Cranial Nerves 5. Trigeminal
- Any muscle wasting - Sensory: Assess light touch and pain sensation of the ophthalmic/maxillary/mandibular branches - Motor: Clench teeth & feel for the bulk of masseter and temporalis bilaterally - Open mouth against resistance - Reflexes ● Corneal reflex needs to discuss only ● Jaw jerk needs to discuss only
133
Head Injury Cranial Nerves 7. Facial
- Inspect the patient's face at rest for asymmetry - Ask the patient to perform the following facial movements: * Raise eyebrows * Scrunched up eyes - assess power * Blown out cheeks - assess power * Baring teeth * Purse lips * Checks anterior 2/3rd of tongue for taste * Tearing
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Head Injury Cranial Nerves 8. Vestibulocochlear
● Gross hearing testing ● Whisper "99" ● Weber's test 512 Hz : lateralisation explain the significance ● Rinne's test 512 Hz : Air V Bone conduction explain the significance
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Head Injury Cranial Nerves 9. Glossopharyngeal 10. Vagus
● Assess speech quality for hoarseness/quietness ● Ask patient to open their mouth and say Ahhhhh ● Assess soft palate and uvula: ● Symmetry ● Swallow ● Glossopharyngeal - Soft palate ● Gag reflex (sensory and motor X ) to discuss only
136
Head Injury Cranial Nerves 11. Spinal Accessory
- Assess the patient from behind - Shrug shoulders & resist - Turn head to 1 side & resist you pushing it to the other - sternocleidomastoid - Trapezius Muscle Strength Sternocleidomastoid Strength
137
Head Injury Cranial Nerves 12. Hypoglossal
● Inspect tongue for wasting and fasciculation at rest ● Protrude tongue and note deviation ● Place your finger on the patient's cheek & ask to push their tongue against Hypoglossal - Tongue in mouth Tongue sticking out Tongue in cheek
138
Head Injury If clinically indicated from history or suspicion, consider testing:
- Limb power - Limb sensation - Coordination - Gait
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Head Injury Management Golden Rules
- Never attribute decreased GCS to alcohol alone - Never let a head injured patient go home alone
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Dangerous mechanisms of neck injury
- High speed RTA - RTA with ejection/rollover - Fall from over 1 metre/5 steps - Axial load to head - Motorised recreational vehicle - Bicycle collision
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Neck Injury History
- Mechanism - Time injury occurred – delayed presentations - Mobility since - When the pain occurred - Previous neck problems - Use of analgesia - Upper limb neurological symptoms
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Neck Injury High risk factors mandating radiography
- Age > 65 - High risk mechanism - Paraesthesia in extremities If these are present – immobilise neck and arrange x rays Also cannot apply rule if: Distracting injuries Alcohol on board GCS not 15
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Low risk factors allowing safe assessment of neck movement
- Simple rear end shunt - Ambulatory at any time - Sitting position in ED - Delayed onset neck pain - Absence of C-spine tenderness
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Neck Injury Canadian C spine rule – end point
If then able to rotate neck 45° left and right No x-ray required Genius!!
145
Neck Injury Look
- Obvious deformity - Cervical lordosis - Swelling - Bruising - Wounds - Skin colour/erythema - Height of shoulders
146
Neck Injury Feel
- Temperature - Spinous process of c-spine - Paraspinal muscles - Major muscles of the neck
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Neck Injury Move
- Rotation - look over shoulder (right and left) - Flexion - touch chin to chest - Extension - look up at the ceiling - Lateral flexion - touch ear to shoulder
148
Neck Injury Upper Limb Neuro Examination
If any concerns from history If dangerous mechanism - Power - Sensation - Reflexes

Minor Injuries Management (1 decks)

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